Lichen sclerosus: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:Lichen sclerosus.jpg|thumb|Lichen sclerosus showing an ivory white coloring in the vulva, and also stretching downward to the perineum.]] | |||
*Skin becomes thin, wrinkles, and whitened | *Skin becomes thin, wrinkles, and whitened | ||
*In males, most commonly affects glans or foreskin<ref>Teichman JM et al. Noninfectious Penile Lesions. Am Fam Physician. 2010 Jan 15;81(2):167-174.</ref> | |||
*Most common symptoms include itching and pain at the affected areas, most commonly the clitoris and labia (although any skin surface can be affected) | *Most common symptoms include itching and pain at the affected areas, most commonly the clitoris and labia (although any skin surface can be affected) | ||
*Other symptoms include anal discomfort, dyspareunia, and dysuria | *Other symptoms include anal discomfort, dyspareunia, and dysuria | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Candidiasis | *[[Candidiasis]] | ||
*Lichen | *[[Lichen planus]] | ||
*Psoriasis | *[[Psoriasis]] | ||
*Dermatitis | *[[Dermatitis]] | ||
{{Vulvovaginitis DDX}} | |||
==Evaluation== | ==Evaluation== | ||
Latest revision as of 12:05, 23 August 2017
Background
- A benign, chronic, progressive dermatologic condition characterized by marked inflammation, epithelial thinning, and distinctive dermal changes accompanied by symptoms of pruritus and pain
- Typically affects postmenopausal women, however it does sometimes occur in men, children, and premenopausal women
- Thought to be related to low estrogen states
Clinical Features
- Skin becomes thin, wrinkles, and whitened
- In males, most commonly affects glans or foreskin[1]
- Most common symptoms include itching and pain at the affected areas, most commonly the clitoris and labia (although any skin surface can be affected)
- Other symptoms include anal discomfort, dyspareunia, and dysuria
Differential Diagnosis
Vulvovaginitis
- Bacterial vaginosis
- Candida vaginitis
- Trichomonas vaginalis
- Contact vulvovaginitis
- Bubble baths and soaps
- Deodorants, powders, and douches
- Clothing
- Atrophic vaginitis due to lack of estrogen (AKA Vulvovaginal atrophy)
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Pinworms
- Vaginal foreign body
- Toilet paper
- Other
- Genitourinary syndrome of menopause
- Foreign body
- Allergic reaction
- Normal physiologic discharge
Evaluation
- Biopsy — A vulvar punch biopsy is taken to demonstrate atypical cell histology
- Histopathology — Epidermis is thinned, areas of hyperkeratosis may be observed. Early lesions may show irregular epidermal acanthosis
- Clinical judgment should guide the diagnosis and treatment of LS when biopsy results are not specific
Management
- Behavioral changes: good hygiene, avoid scratching area
- topical steroids such as clobetasol proprionate
Disposition
- Can be chronic
- Increases chance of vulvar squamous cell carcinoma
See Also
External Links
References
- ↑ Teichman JM et al. Noninfectious Penile Lesions. Am Fam Physician. 2010 Jan 15;81(2):167-174.