litchen sclerosis

Question 1

what is lichen sclerosis

Answer 1

a chronic autoimmune, inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin.

Question 2

where does lichen sclerosis commonly affect in women

Answer 2

• mainly labia, perineum and perianal skin
• can affect other areas, such as the axilla and thighs

Question 3

where does lichen sclerosis affect in men

Answer 3

typically on the foreskin and glans of the penis.

Question 4

dx of lichen sclerosis

Answer 4

clinically, based on the history and examination findings

• in doubt a vulval biopsy can confirm the diagnosis.

Question 5

is lichen sclerosis the same as lichen simplex or lichen planus.

Answer 5

no

Question 6

what is lichen simplex

Answer 6

chronic inflammation and irritation caused by repeated scratching and rubbing of an area of skin.

• presents with excoriations, plaques, scaling and thickened skin.

Question 7

what is lichen planus

Answer 7

an autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.

Question 8

typical demographic of lichen sclerosis px

Answer 8

a woman aged 45 – 60 years complaining of vulval itching and skin changes in the vulva.

may be asymptomatic, or present with several symptoms:

Question 9

sx of lichen sclerosis

Answer 9

Itching
Soreness and pain possibly worse at night
Skin tightness
Painful sex (superficial dyspareunia)
Erosions
Fissures

Question 10

what is Koebner phenomenon

Answer 10

when the signs and symptoms are made worse by friction to the skin. This occurs with lichen sclerosus.

can be made worse by tight underwear that rubs the skin, urinary incontinence and scratching.

Question 11

appearance of skin in lichen sclerosis

Answer 11

“Porcelain-white” in colour
Shiny
Tight
Thin
Slightly raised
There may be papules or plaques

Question 12

who manages lichen sclerosis

Answer 12

managed and followed up every 3 – 6 months by an experienced gynaecologist or dermatologist.

Question 13

main tx of lichen sclerosis

Answer 13

Potent topical steroids - clobetasol propionate 0.05% (dermovate)

initially used once a day for four weeks, then gradually reduced in frequency every four weeks to alternate days, then twice weekly.

Question 14

maintenace tx of lichen sclerosis

Answer 14

emollients

Question 15

main complication of lichen sclerosis

Answer 15

5% risk of developing squamous cell carcinoma of the vulva.

Question 16

minor complications of lichen sclerosis

Answer 16

Pain and discomfort
Sexual dysfunction
Bleeding
Narrowing of the vaginal or urethral openings