Lichen sclerosus

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**Lichen sclerosus**
*Classification & external resources*
ICD-10	L90.0
ICD-9	701.0

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.

It is an autoimmune disease and can be associated with hypothyroidism.

Women are more commonly affected than men, particularly around and after menopause, but girls may also get 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. [1] In men, this genital involvement has traditionally been known as balanitis xerotica obliterans (BXO).[2]

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.

Diagnosis needs sometime biopsy because 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 long time. Occasionally, spontaneous cure may ensue, particularly in young girls.

When it occurs on the vulva, it leads in 1-4 % of cases to 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.[3] Periodic consultation is therefore necessary.

LS may cause sufferers to feel depressed due to their condition, due to the pain caused and feelings that they are 'not normal', 'can't have sex properly', 'the only one like this' and other self-esteem issues. It may be useful for them to contact other sufferers and speak to them, to see they are not alone and since they may understand what they are feeling better than non-sufferers, or speak a counsellor to work through any issues. Support groups exist for sufferers who may be able to help in this respect, one example is the National Lichen Sclerosus Support Group which is based in the UK, but does have an international membership. Their website also contains a lot of useful information on Lichen Sclerosis, its symptoms and its treatment.