Lichen Sclerosus (LS) is a relativeley uncommon chronic inflammatory diseasethat often affects the external genitalia and perianal area. In 10% of cases there is also extragenital involvement. LS of the external genitalia has also been associated with squamous cell carcinoma of the penis and vulva.
LS is 6-10 times more common in women where it often presents around menopause. In men LS is often seen in older men aged greater than 60 years. 15% of LS cases occur in children, mainly females, where there is a peak between 8 and 13 years of age. In men, LS is more likely to occur in uncircumcised or incompletely circumcised men. The glans and foreskin are commonly affected and it may also be known as balanitis xerotica obliterans. In women it …show more content…
It may occur anywhere in the body, but it has most commonly been reported in the inner thigh, buttocks, under the breasts, neck, shoulders and armpits. There have been no reported cases of these being assosciated with squamous cell carcinoma.
There are no systemic manifestations.
Definitve diagnosis of LS is by biopsy and this is also useful to exclude malignant change. LS has a specific histological lichenoid pattern. Things to look out for are epidermal hyperkeratosis and thinning, vacuolar degeneration at the dermal-epidemal junction and loss of elasticity. Pale staining in the superficial dermis is also a dominant feature, in early stages of LS this will represent dermal oedema while in the late stages this represents dermal collagen.
L.S. is a clinical diagnosis, however a number of investigations may be helpful.
Baseline blood tests such as FBC, U&Es and LFTs are useful in view of management. An autoantibody screen including thyroid function tests may be considered in screening for associated conditions. Low ferritin levels may cause pruritus mimicking or exacerbating features of L.S.
Swabs may be sent for microbiology in erosive lesions to exclude superimposed herpes simplex or candida
LS is 6-10 times more common in women where it often presents around menopause. In men LS is often seen in older men aged greater than 60 years. 15% of LS cases occur in children, mainly females, where there is a peak between 8 and 13 years of age. In men, LS is more likely to occur in uncircumcised or incompletely circumcised men. The glans and foreskin are commonly affected and it may also be known as balanitis xerotica obliterans. In women it …show more content…
It may occur anywhere in the body, but it has most commonly been reported in the inner thigh, buttocks, under the breasts, neck, shoulders and armpits. There have been no reported cases of these being assosciated with squamous cell carcinoma.
There are no systemic manifestations.
Definitve diagnosis of LS is by biopsy and this is also useful to exclude malignant change. LS has a specific histological lichenoid pattern. Things to look out for are epidermal hyperkeratosis and thinning, vacuolar degeneration at the dermal-epidemal junction and loss of elasticity. Pale staining in the superficial dermis is also a dominant feature, in early stages of LS this will represent dermal oedema while in the late stages this represents dermal collagen.
L.S. is a clinical diagnosis, however a number of investigations may be helpful.
Baseline blood tests such as FBC, U&Es and LFTs are useful in view of management. An autoantibody screen including thyroid function tests may be considered in screening for associated conditions. Low ferritin levels may cause pruritus mimicking or exacerbating features of L.S.
Swabs may be sent for microbiology in erosive lesions to exclude superimposed herpes simplex or candida