An Overview of Lichen Sclerosus

Authors

  • Jennifer Tran, MD

Abstract

Lichen sclerosus (LS) is a chronic, inflammatory disease that typically affects the genital skin, and less frequently on other skin sites. It is characterized by white, shiny, scar-like atrophy. Symptoms include pruritus, burning, progressive atrophy, and in severe cases, loss of normal genital architecture, and functional impairment.

Author Biography

Jennifer Tran, MD

Dr. Jennifer Tran is a board-certified dermatologist in Canada and the U.S. with expertise in medical, surgical, and cosmetic dermatology. Dr. Tran completed her undergraduate training in Health Sciences at McMaster University. She then completed her medical degree and subsequently her dermatology residency at the University of Toronto, where she served as chief resident during her final year of training. She is currently working at several community clinics and runs an academic practice at Sunnybrook Health Sciences Centre.

References

Goldstein AT, Marinoff SC, Christopher K, Srodon M. Prevalence of vulvar lichen sclerosus in a general gynecology practice. J Reprod Med. 2005;50(7):477-480.

Bleeker MC, Visser PJ, Overbeek LI, van Beurden M, Berkhof J. Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma. Cancer Epidemiol Biomarkers Prev. 2016;25(8):1224-1230. doi:10.1158/1055-9965.EPI-16-0019.

Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013;14(1):27-47. doi:10.1007/s40257-012-0006-4.

Gao XH, Barnardo MC, Winsey S, et al. The association between HLA DR, DQ antigens, and vulval lichen sclerosus in the UK: HLA DRB112 and its associated DRB112/DQB10301/04/09/010 haplotype confers susceptibility to vulval lichen sclerosus, and HLA DRB10301/04 and its associated DRB10301/04/DQB10201/02/03 haplotype protects from vulval lichen sclerosus. J Invest Dermatol. 2005;125(5):895-899. doi:10.1111/j.0022-202X.2005.23905.

Marren P, Yell J, Charnock FM, Bunce M, Welsh K, Wojnarowska F. The association between lichen sclerosus and antigens of the HLA system. Br J Dermatol. 1995;132(2):197-203. doi:10.1111/j.1365-2133.1995.tb05013.

Powell J, Wojnarowska F, Winsey S, Marren P, Welsh K. Lichen sclerosus premenarche: autoimmunity and immunogenetics. Br J Dermatol. 2000;142(3):481-484. doi:10.1046/j.1365-2133.2000.03360.

Meyrick Thomas RH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus et atrophicus and autoimmunity–a study of 350 women. Br J Dermatol. 1988 Jan;118(1):41-6. doi: 10.1111/j.1365-2133.1988.tb01748.x.

Cooper SM, Ali I, Baldo M, Wojnarowska F. The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case-control study. Arch Dermatol. 2008 Nov;144(11):1432-5. doi: 10.1001/archderm.144.11.1432. PMID: 19015417.

Eisendle K, Grabner T, Kutzner H, Zelger B. Possible role of Borrelia burgdorferi sensu lato infection in lichen sclerosus. Arch Dermatol. 2008;144(5):591-598. doi:10.1001/archderm.144.5.591.

Requena López S, Hidalgo García Y, Gómez Díez S, Vivanco Allende B. Morphea and Extragenital Lichen Sclerosus et Atrophicus After Influenza Vaccination. Morfea y liquen escleroatrófico extragenital generalizados tras vacuna antigripal. Actas Dermosifiliogr. 2018;109(1):86-88. doi:10.1016/j.ad.2017.05.016.

Pass CJ. An unusual variant of lichen sclerosus et atrophicus: delayed appearance in a surgical scar. Cutis. 1984;33(4):405-408.

De Giorgi V, Scarfì F, Silvestri F, et al. Genital piercing: A warning for the risk of vulvar lichen sclerosus. Dermatol Ther. 2021;34(1):e14703. doi:10.1111/dth.14703.

Fergus KB, Lee AW, Baradaran N, et al. Pathophysiology, Clinical Manifestations, and Treatment of Lichen Sclerosus: A Systematic Review. Urology. 2020;135:11-19. doi:10.1016/j.urology.2019.09.034.

Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th edition. Elsevier; 2018.

Patterson, J. Weedon’s Skin Pathology. 4th Edition. Elsevier; 2014.

Rapini, R. Practical Dermatopathology. Elsevier; 2012.

Kirtschig G, Becker K, Günthert A, et al. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol. 2015;29(10):e1-e43. doi:10.1111/jdv.13136.

Kim GW, Park HJ, Kim HS, et al. Topical tacrolimus ointment for the treatment of lichen sclerosus, comparing genital and extragenital involvement. J Dermatol. 2012;39(2):145-150. doi:10.1111/j.1346-8138.2011.01384.x.

Cattaneo A, Carli P, De Marco A, et al. Testosterone maintenance therapy. Effects on vulvar lichen sclerosus treated with clobetasol propionate. J Reprod Med. 1996;41(2):99-102.

Bornstein J, Heifetz S, Kellner Y, Stolar Z, Abramovici H. Clobetasol dipropionate 0.05% versus testosterone propionate 2% topical application for severe vulvar lichen sclerosus. Am J Obstet Gynecol. 1998 Jan;178(1 Pt 1):80-4. doi: 10.1016/s0002-9378(98)70631-3.

Cuellar-Barboza A, Bashyam AM, Ghamrawi RI, Aickara D, Feldman SR, Pichardo RO. Methotrexate for the treatment of recalcitrant genital and extragenital lichen sclerosus: A retrospective series. Dermatol Ther. 2020;33(4):e13473. doi:10.1111/dth.13473.

Bousema MT, Romppanen U, Geiger JM, et al. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study. J Am Acad Dermatol. 1994;30(2 Pt 1):225-231. doi:10.1016/s0190-9622(94)70021-4.

Ioannides D, Lazaridou E, Apalla Z, Sotiriou E, Gregoriou S, Rigopoulos D. Acitretin for severe lichen sclerosus of male genitalia: a randomized, placebo controlled study. J Urol. 2010;183(4):1395-1399. doi:10.1016/j.juro.2009.12.057.

Shelley WB, Shelley ED, Amurao CV. Treatment of lichen sclerosus with antibiotics. Int J Dermatol. 2006;45(9):1104-1106. doi:10.1111/j.1365-4632.2006.02978.x.

Gardner AN, Aschkenazi SO. The short-term efficacy and safety of fractional CO2 laser therapy for vulvovaginal symptoms in menopause, breast cancer, and lichen sclerosus [published online ahead of print, 2021 Jan 4]. Menopause. 2021;Publish Ahead of Print:10.1097/GME.0000000000001727. doi:10.1097/GME.0000000000001727.

Eckert MM, Bilbao JT, Estévez IZ, Gundin NL. Treatment of Vulvar Lichen Sclerosus et Atrophicus With Fractional Carbon Dioxide Laser Therapy: A Report of 4 Cases. Tratamiento de liquen escleroso y atrófico vulvar con láser de dióxido de carbono fraccionado. Presentación de cuatro casos. Actas Dermosifiliogr. 2021;112(1):85-88. doi:10.1016/j.ad.2019.03.021.

Mendieta-Eckert M, Ocerin-Guerra I, Landa-Gundin N. Lichen sclerosus et atrophicus in a surgical scar treated with fractional laser. J Cosmet Laser Ther. 2017;19(2):106-108. doi:10.1080/14764172.2016.1262955.

Lee A, Lim A, Fischer G. Fractional carbon dioxide laser in recalcitrant vulval lichen sclerosus. Australas J Dermatol. 2016;57(1):39-43. doi:10.1111/ajd.12305.

Pagano, Tiziana, et al. “Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study.” Menopause. 2020 Apr;27(4):418-422.

Ferrara F, Messori S, Abbenante D, Patrizi A, Bardazzi F. Fractional CO2 laser therapy of lichen sclerosus in males: a new therapeutic opportunity? [published online ahead of print, 2020 Jul 20]. J Dermatolog Treat. 2020;1-5. doi:10.1080/09546634.2020.1793886.

Tedesco M, Pranteda G, Chichierchia G, et al. The use of PRP (platelet-rich plasma) in patients affected by genital lichen sclerosus: clinical analysis and results. J Eur Acad Dermatol Venereol. 2019;33(2):e58-e59. doi:10.1111/jdv.15190.

Behnia-Willison F, Pour NR, Mohamadi B, et al. Use of Platelet-rich Plasma for Vulvovaginal Autoimmune Conditions Like Lichen Sclerosus. Plast Reconstr Surg Glob Open. 2016;4(11):e1124. Published 2016 Nov 23. doi:10.1097/GOX.0000000000001124.

Casabona F, Gambelli I, Casabona F, Santi P, Santori G, Baldelli I. Autologous platelet-rich plasma (PRP) in chronic penile lichen sclerosus: the impact on tissue repair and patient quality of life. Int Urol Nephrol. 2017;49(4):573-580. doi:10.1007/s11255-017-1523-0.

Navarrete J, Echarte L, Sujanov A, et al. Platelet-rich plasma for male genital lichen sclerosus resistant to conventional therapy: First prospective study. Dermatol Ther. 2020;33(6):e14032. doi:10.1111/dth.14032.

Tedesco M, Garelli V, Bellei B, et al. Platelet-rich plasma for genital lichen sclerosus: analysis and results of 94 patients. Are there gender-related differences in symptoms and therapeutic response to PRP? [published online ahead of print, 2020 Dec 6]. J Dermatolog Treat. 2020;1-5. doi:10.1080/09546634.2020.1854650.

Published

2021-05-01

How to Cite

1.
Tran J. An Overview of Lichen Sclerosus. Can Dermatol Today [Internet]. 2021 May 1 [cited 2024 May 20];2(2):15–18. Available from: https://canadiandermatologytoday.com/article/view/2-2-tran

Issue

Section

Articles