Lichen sclerosus (LS) is the most common chronic vulvar condition. It is characterized by vulvar hypopigmentation and scarring with loss of normal architecture. Onset is typically at 35-45 years of age, but it can be seen in prepubertal children. Genetic and autoimmune factors are thought to contribute to the pathogenesis of LS.
The main symptom is pruritus, and at times, this can be incapacitating, interfering with daily activity and sleep. Dyspareunia and urinary retention may occur. It can also be asymptomatic, just with scarring and hypopigmentation.
Squamous cell carcinoma (SCC) can occur within LS genital lesions. There is a higher risk of SCC in untreated cases.
Lichen sclerosus - Anogenital in
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Important News & Links
Synopsis
Codes
ICD10CM:
L90.0 – Lichen sclerosus et atrophicus
SNOMEDCT:
895454001 – Lichen sclerosus
L90.0 – Lichen sclerosus et atrophicus
SNOMEDCT:
895454001 – Lichen sclerosus
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Bowen disease – Four percent of patients can have an associated squamous cell carcinoma.
- Chronic radiation dermatitis – Previously radiated in that area.
- Mucous membrane pemphigoid – Look for blisters and erosions, scarring, and stricture formation in later stages.
- Extramammary Paget disease – Look for lichenified or verrucous, dry to macerated plaques.
- Infiltrating basal cell carcinoma – Look for pearly areas and prominent telangiectasias.
- Lichen planus – Look for white streaks (Wickham striae).
- Lichen simplex chronicus – Look for lichenification with exaggerated skin markings on glabrous areas of vulva only, often with excoriations.
- Postmenopausal atrophy – Postmenopausal patient with vaginal dryness and atrophy.
- Psoriasis – Look for psoriasis on other body sites.
- Scar – History of trauma.
- Vitiligo – Bright white fluorescence on Wood's lamp.
- Bullous pemphigoid
- Recessive dystrophic epidermolysis bullosa (vulvar lesions)
- Junctional epidermolysis bullosa (vulvar lesions)
Best Tests
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Management Pearls
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Therapy
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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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References
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Last Reviewed:08/12/2020
Last Updated:01/18/2022
Last Updated:01/18/2022
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Lichen sclerosus - Anogenital in
See also in: Overview,External and Internal Eye