2nd July 2023

Lichen Sclerosus

A chronic inflammatory skin disorder that most commonly affects the genital and perianal areas and is ten times more common in women than in men. It tends to occur in women over 50. The causes are likely to be a combination of factors, including genetics, hormonal, irritant, traumatic and infectious elements. Some cases are thought to be autoimmune with 60-80% of patients having extracellular matrix protein-1 (ECM01) antibodies.

Clinical features

Non-hair-bearing parts of the vulva are affected and it usually presents as itching and soreness. Sometimes bruising and ulceration occurs from scratching and minimal friction. In some cases, urination can cause stinging and patients can experience uncomfortable sexual intercourse. It can spread to the surrounding skin of labia majora and inguinal folds, as well as the anal and perianal skin area but never involves vaginal mucosa. Patients are often more prone to infections such as thrush (candida albicans), herpes simplex and staphylococcus aureus. It has been associated with an increased risk of vulval, penile or anal squamous cell carcinoma in up to 5% of patients.

Investigation and management

It is primarily a clinical diagnosis, however, skin biopsy can help aid diagnosis.

The main treatment is initially with a strong topical steroid ointment such as clobetasol propionate 0.05%. Once symptoms are more controlled, steroid ointment can be reduced in strength.