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Lichen sclerosus

Lichen sclerosus (LS) (also known as lichen sclerosus et atrophicus (LSA), white-spot disease) is an uncommon disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin.

Several risk factors have been proposed, including autoimmune diseases, infections and genetic predisposition The disease can be associated with thyroid disease..

Synonyms and short history

Lichen Sclerosis (LS), Lichen Sclerosus et Atrophicus (LSA), Balanitis xerotica obliterans (BXO), Csillag's disease, White Spot Disease, kraurosis vulvae, lichen albus and lichen sclerosus et atrophicans. These are all different names for the same disease. Typically it's called LSA or BXO when it affects men, LS when it affects women or in referring to the disease in general.

LS was first described in 1887 by Dr. Hallopeau. In 1989 the International Society for the Study of Vulvovaginal Disease (ISSVD) officially proclaimed the name ‘lichen sclerosus’. Since then this is the official medical name for this disease.

General

Women are more commonly affected than men, particularly around and after menopause, but younger women or girls may also develop the disease. The condition most commonly occurs on the vulva and around the anus with ivory-white elevations that may be flat and glistening. There may be marked itching or the condition may be without any symptoms. There may also be thinning and shrinkage of the genital area that may make coitus painful.

In males, the disease may take the form of whitish thickening of the foreskin, which cannot be retracted easily. One study has revealed that 51 (98%) of 52 patients diagnosed with penile LS were uncircumcised. In men, this genital involvement has traditionally been known as balanitis xerotica obliterans (BXO).

On the non-genital skin, the disease may manifest as porcelain-white spots with small visible plugs inside the orifices of hair follicles or sweat glands on the surface. Thinning of the skin may also occur.

A biopsy is sometimes required for proper diagnosis, as LSA may be difficult to differentiate from condyloma. Histologically there's hyperkeratosis, atrophic epidermis, sclerosis of dermis and lymphocyte activity in dermis.

The disease often goes undiagnosed for several years, as it is sometimes not recognised and misdiagnosed as thrush or other problems and not correctly diagnosed until the patient is referred to a specialist when the problem does not clear up.

The disease can last for a considerably long time. Occasionally, "spontaneous cure" may ensue, particularly in young girls.

Lichen sclerosis does not cause cancer. However, skin that has been scarred as a result of lichen sclerosis is more likely to develop skin cancer. One to 4% of women with lichen sclerosis may develop vulvar carcinoma. For men it might be a major cause for tight foreskin, phimosis.

LS is usually treated with application of potent steroids, which may cause relief and prevent scarring. Other options are cryotherapy, and laser therapy. Occasionally, cancer may develop on the patches. Periodic consultation is therefore necessary.

LS may cause sufferers to feel depressed due to their condition, due to the pain caused. They may feel that they are 'not normal', 'can't have sex properly', 'the only one like this' and develop self-esteem issues. In such situations, it may be helpful to speak with a counsellor to work through such issues. Contact with support groups may also allow sufferers to realise that they are not alone, and that there are others who understand how they feel.

References

Neill SM, Tatnall FM, Cox NH (2002). "Guidelines for the management of lichen sclerosus". Br. J. Dermatol. 147 (4): 640–9.

External links

Support groups

Medical information

Medical pictures

http://www.dermlectures.com/LecturesWMV.cfm?lectureID=88
http://dermis.multimedica.de/dermisroot/de/34088/diagnose.htm
http://dermnetnz.org/immune/ls-imgs.html

Medical Literature

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Marren P, Cherry C, Day A et al. Lichen Sclerosus: the patient, the hormon influenceonal i and disease impact (abstract) Br J Dermatol 1995;21:133.Lorenz B, Kaufman RH, Kutzner SK (1998). "Lichen sclerosus. Therapy with clobetasol propionate". J Reprod Med 43 (9): 790–4.

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