The earliest signs are skin fragility, bruising, and sometimes blistering. Lesions typically cause mild to severe itching. When lichen sclerosus manifests in children, the appearance may be confused with sexual abuse. With time, the involved tissue becomes atrophic, thinned, hypopigmented (there may be flecks of postinflammatory hyperpigmentation), fissured, and scaly. Hyperkeratotic and fibrotic forms exist.
Severe and longstanding cases cause scarring and distortion or absorption of normal anogenital architecture. In women, this distortion can even lead to total destruction of the labia minora and clitoris. In men, phimosis or fusion of the foreskin to the coronal sulcus can occur.
Diagnosis of lichen sclerosus can usually be based on appearance, especially in advanced cases; however, biopsy should be done on any anogenital dermatosis that does not resolve with mild conventional therapy (eg, topical hydrocortisone, antifungal drug). It is especially important to biopsy any area that becomes thickened or ulcerated, because lichen sclerosus is associated with an increased frequency of squamous cell carcinoma.
Treatment of lichen sclerosus consists of potent topical corticosteroids (drugs that otherwise should be used with extreme caution in this area). The disease is generally intractable, so long-term treatment and follow-up are necessary.
Monitoring for squamous cell carcinoma and sexual dysfunction and providing psychologic support are indicated.
Lichen sclerosus can cause anogenital bruising, itching, or blistering early, and atrophy and scarring later.
Risk of subsequent squamous cell carcinoma is increased.
Consider the diagnosis with any persistent anogenital dermatosis.
Treat with long-term, high-potency topical corticosteroids, close monitoring, and sexual and psychologic support.