Lichen Sclerosus – Diagnosis and Treatment

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Lichen sclerosis is a skin condition caused by an autoimmune disorder in which the immune system attacks healthy cells and creates lesions. The exact cause of lichen sclerosis is not entirely understood. Low levels of estrogen may also contribute to the development of this condition. Regardless of the cause, doctors can quickly diagnose lichen sclerosis through a physical exam and review of the patient’s medical history. If necessary, a skin biopsy may be performed to confirm the diagnosis further.

Symptoms

A physician or dermatologist can diagnose lichen sclerosis on the skin by examining the affected area. The condition is not contagious and cannot be passed on through sexual contact. A doctor or dermatologist may do a skin biopsy to confirm the diagnosis. Treatment options include topical corticosteroid creams and ointments, relieving itching and inflammation.

The rash caused by lichen sclerosus typically appears as raised and shiny white patches, sometimes joining into larger patches. This type of skin disorder is most common in women after menopause and between the ages of 40 to 60. However, it is rare in men or girls who have not reached puberty.

The anogenital area can also be affected by lichen sclerosus. In women, the vagina may become narrow, and the outer and inner lips of the vulva may stick together. Men may also experience pain during sex and a weakened clitoral hood. For men, lichen sclerosis can cause pain during sex and may affect the penile shaft.

Diagnosis

Diagnosis of lichen sclerosis in the genital region is challenging, particularly without apparent clinical changes. A biopsy may reveal a quite advanced disease, with progressive sclerosis and irreversible structural damage. Unfortunately, only 50% of cases have a pathognomonic histological picture, meaning that strict criteria for diagnosis would miss nearly half of cases.

Regardless of how the condition is diagnosed, it’s essential to understand the symptoms. While it isn’t a life-threatening disease, it can significantly impair the quality of life. Therefore, it is essential to seek treatment for all patients with lichen sclerosis, especially those who experience sexual dysfunction. In addition to treatment, patient education is essential, and physicians should refer patients to a specialist if necessary.

In women, lichen sclerosis commonly affects the labia majora, although it can affect the labia minora in men. It may also affect the perianal region and vagina. In up to 15% of cases, the genital region is affected. Other common locations include the thighs, back, neck, and wrists. A punch biopsy can help confirm a diagnosis of lichen sclerosis.

Treatment

The first step in treating lichen sclerosis is to make a diagnosis. This is often accomplished through biopsy. A biopsy can also provide additional information about the disease, such as the exact type and severity. Treatment options depend on the type of disease and the patient’s overall health. A patient with a diagnosis of lichen sclerosus may undergo a variety of treatments, including topical steroid creams and lotions.

In some cases, surgical treatments are necessary. Some types of surgery, such as vaginal enucleation, remove patches from the vagina. This treatment isn’t necessary for all patients, but it may be an option for patients with severe vaginal lichen sclerosis.

Steroids may be prescribed for women with genital lichen sclerosus, but there are risks associated with their use. These drugs may cause adverse effects, including genital yeast infections and stretch marks. Other treatment options include vitamin A-like drugs (retinoids) and ultraviolet light therapy.

Complications

The treatment for lichen sclerosis varies, and you should consult a doctor experienced in this condition. The most common form of treatment is the application of a potent corticosteroid ointment, which is applied to the affected area for many weeks.

If left untreated, lichen sclerosis can permanently change the appearance of the genitals. The vagina may narrow, and the outer and inner lips of the vulva may stick together, causing discomfort. In men, the foreskin can also become scarred and may hinder pulling back the foreskin. As a result, men may experience pain during sex. The condition can also increase the risk of skin cancer.

The earliest stage of the disease is characterized by a moderately heavy lymphocytic infiltrate in the basal epidermis. It is accompanied by a basal vacuole and the formation of hemorrhagic bullae. Next, the disease progresses to the point that elastic fibers of the papillary dermis are lost. Finally, the condition progresses to a subepidermal edema phase, where the dermal inflammatory infiltrates move downwards and is replaced by fibrosis.

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