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Lichen sclerosus in Child
See also in: External and Internal Eye,Anogenital
Other Resources UpToDate PubMed

Lichen sclerosus in Child

See also in: External and Internal Eye,Anogenital
Contributors: Sabrina Nurmohamed MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Lichen sclerosus is a chronic dermatosis of uncertain etiology affecting the skin and mucosa of individuals of all races. Lichen sclerosus most commonly presents in 2 peaks of incidence: postmenopausal women and prepubertal girls. Childhood and adolescent cases in boys have increasingly been recognized. Lesions occur mostly on the genitalia, perineum, or perianal skin, but extragenital lesions are also observed. Lichen sclerosus lesions are atrophic patches or ivory-white plaques preceded by papules. Because of petechiae, erosions, and purpura, the disease can easily be mistaken for sexual abuse in young girls. Lesions can itch, burn, and cause dysuria, constipation, and painful defecation. Advanced disease may obliterate genital anatomy. Extragenital lesions are rarely symptomatic.

There is a well-documented association of lichen sclerosus and autoimmune diseases such as alopecia areata, autoimmune thyroiditis, and vitiligo. Some cases are thought to due to infectious etiology including Borrelia spp. and hepatitis C virus.

Lichen sclerosus does not usually resolve with puberty, but it may improve.

An increased risk of genital squamous cell carcinoma (SCC) has been observed in adult male and female patients with chronic untreated genital lichen sclerosus. For girls and women with vulvar lichen sclerosus, the lifetime risk of vulvar SCC is about 5%.


L90.0 – Lichen sclerosus et atrophicus

895454001 – Lichen sclerosus

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Sexual abuse – Disrupted hymen, may have an associated sexually transmitted disease, purpura, and bruising outside of atrophic areas; a diagnosis of lichen sclerosus does not exclude concomitant sexual abuse, and social work should investigate when suspicion is high.
  • Trauma (straddle injury) – no atrophy, consistent history
  • Scars – firm, smooth, indurated plaques
  • Morphea – indurated; lilac-colored or hyperpigmented border
  • Vitiligo – well-defined depigmentation, often not in hourglass configuration, lacks signs of atrophy (purpura, telangiectasias, fine wrinkling, and fissures)
  • Lichen planus
  • Lichen simplex chronicus
  • Psoriasis
  • Cutaneous candidiasis – may have erosions, but no atrophy; erythema and satellite lesions
  • Allergic or irritant dermatitis – may have postinflammatory hypopigmentation, pruritus, erythema, and erosions, but no purpura or telangiectasias
  • Bullous pemphigoid

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:03/08/2017
Last Updated:01/18/2022
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Patient Information for Lichen sclerosus in Child
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Contributors: Medical staff writer


Lichen sclerosus refers to a type of inflammation, bleeding, thinning, scarring, and resultant white plaques of the mucous membrane and skin in the genital area, or possibly elsewhere on the body. Its origin is uncertain. There may be a genetic association among some family members.

Lichen sclerosus lesions may resemble childhood or adult sexual abuse. Your doctor may need to rule out this possibility.

Who’s At Risk

Lichen sclerosus is reported 6 times more often in females than males. In females, it is most often genital and presents either before puberty or after menopause. Lichen sclerosus in males is almost always in uncircumcised boys and men.

Women with genital lichen sclerosus may have a slightly greater risk of skin cancer.

Lichen sclerosus is rarely seen in infants.

Signs & Symptoms

Lichen sclerosus of the anogenital area begins with inflamed, dry, sore, and very itchy areas of genital skin. It may progress to painful, bleeding, red or purple lesions. Female symptoms can include pain during urination, defecation, or intercourse. In males, lesions may occur on the head and shaft of the penis. Other symptoms may include itching and painful urination, defecation, and erection. Impaired sensation of the penis may occur.

Lichen sclerosus of other skin areas may occur without any symptoms, or may appear as dry, itchy skin patches. White, scar-like areas appear on the shoulders, arms, neck, and back. It may appear in tattoos or previously injured skin (surgical scars, trauma, burns).

Rarely does it occur in the mouth.

Self-Care Guidelines

Use only mild cleansers. Follow the directions of your health care provider to alleviate the pain, itch, and discomfort of the condition.

When to Seek Medical Care

When the skin and mucous membranes begin to show signs of aggravated reddening, irritation, itching, and skin plaques, contact your doctor.

If conditions worsen following your medical appointment, contact your doctor for follow-up. Lichen sclerosus, if left untreated, can cause irreversible damage to skin and mucous membranes.


Your health care provider may perform tests to rule out other conditions or infections, or to confirm your diagnosis prior to starting treatment. Your health care provider may perform a biopsy to rule out malignancy and other white plaque conditions. A biopsy is not ordinarily performed on children, except in extreme cases.

Treatment of symptoms, particularly itching, may be the first approach. Topical steroids have been used with great success. A number of other treatments have had mixed results, such as surgery, injections, cryotherapy, phototherapy, and other laser therapy. Circumcision is believed to be helpful for men.
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Lichen sclerosus in Child
See also in: External and Internal Eye,Anogenital
A medical illustration showing key findings of Lichen sclerosus : Eyelids, Glans of penis, Labia majora, Smooth plaque, White color, Inguinal region, Pruritus, Skin atrophy, Hardened skin
Clinical image of Lichen sclerosus - imageId=174921. Click to open in gallery.  caption: 'A shiny white plaque in the intergluteal fold.'
A shiny white plaque in the intergluteal fold.
Copyright © 2023 VisualDx®. All rights reserved.