Lichen sclerosus - Anogenital in
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Synopsis
In children, it is the most common skin condition mistaken for sexual abuse. Although onset is typically around 35-45 years of age, about 7%-15% of cases begin in childhood.
LS may be asymptomatic, although it often results in pruritus and burning. Additionally, there may pain on defecation, constipation, dysuria, or anal or genital bleeding. A major goal of treatment for male pediatric anogenital LS is to prevent urethral stricture.
Children may seek parental attention. They may also present with behavioral changes; for example, caregivers (teachers, parents) may describe a child as "always having their hands in their pants," "rubbing on everything," and "unable to sit still." Behavior caused by itching may be misinterpreted as masturbation that is persistent and resistant to requests to stop.
Misdiagnosis for sexual abuse most often occurs when the presentation is bullous, hemorrhagic, or erosive. Submucosal hemorrhages ("blood blisters") are rarely due to sexual abuse and are a common finding in LS. The presence of hypopigmentation, atrophic skin, and telangiectasias should help differentiate this condition from sexual maltreatment. Findings of confirmed sexual abuse are primarily associated with acute injuries to the genitalia, anus, or oral cavity, genital scarring, sexually transmitted diseases, or evidence of a deep notch. Case reports of LS coexisting with child abuse have been documented.
Childhood sexual abuse can affect children of all ages and economic and cultural backgrounds. Practitioners working with this population should consider this diagnosis routinely. Childhood sexual abuse is a serious allegation with major repercussions to a child and their family, and the differential diagnosis of genital lesions suggestive of sexual abuse includes LS and other anogenital dermatoses.
Genital LS confers a small risk of squamous cell carcinoma (SCC).
Codes
ICD10CM:L90.0 – Lichen sclerosus et atrophicus
SNOMEDCT:
895454001 – Lichen sclerosus
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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.Subscription Required
References
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Last Reviewed:03/08/2023
Last Updated:03/09/2023
Last Updated:03/09/2023
Patient Information for Lichen sclerosus - Anogenital in
Overview
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.
Treatments
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.
Lichen sclerosus - Anogenital in
See also in: Overview,External and Internal Eye