Lichen sclerosus

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 19 Jun 2025

最后更新： 12 Sep 2024

Lichen sclerosus (LS, also known as balanitis xerotica obliterans in men) is an inflammatory skin condition with a chronic relapsing and remitting course.

Characteristic findings on exam of the cutaneous lesions are atrophic white plaques, typically found in the anogenital area, which may lead to scarring and anatomic changes.

There is a small but significant risk (approximately 5%) of vulvar squamous cell carcinoma in women with anogenital LS, especially if left untreated.

If extragenital disease is found, genital exam is recommended, as extragenital disease in isolation is rare.

The condition is often associated with autoimmune conditions (such as thyroid disease and vitiligo) in women.

Diagnosis is predominantly clinical, but confirmation by biopsy is recommended if there is diagnostic uncertainty or suspicion of malignancy.

First-line treatment for all patients with anogenital LS is a very-high potency corticosteroid. Initial management comprises daily therapy until the disease is controlled. In men and boys with genital LS, early circumcision is often curative.

Treatment of extragenital LS should be overseen by a specialist who will individualize the approach according to the site involved, typically only initiating therapy if symptoms are bothersome to the patient.

Once disease control is achieved, maintenance therapy (usually with a topical corticosteroid) may be required for the prevention of anogenital disease flares in particular.

定义

Lichen sclerosus (LS) is a chronic inflammatory skin condition. LS typically affects the genitalia but can also manifest as extragenital lesions.[1][2] In women, it predominantly affects the vulva and anus and is associated with pruritus, pain, and dyspareunia; it can also lead to scarring and increases the risk of malignancy.[3][4][5] In men, genital disease almost exclusively occurs in those who are uncircumcised and may cause pain, dyspareunia, and scarring-related signs and symptoms such as changes in urinary stream and phimosis.[6] Girls may present with similar symptoms as women; however, boys with the condition are usually asymptomatic and often present with phimosis.[7][8][9]

病史和体格检查

关键诊断因素

changes in skin color and/or texture
purpura and/or ecchymoses
pruritus
sclerosis/scarring and/or loss of normal anatomic structures
dyspareunia and/or sexual dysfunction
fissures

完整详情

其他诊断因素

skin irritation and/or discomfort and/or pain
uncircumcised state
erosions
excoriations
Koebnerization
urinary dribbling and/or incontinence
dysuria
lichenification and/or hyperkeratosis
painful defecation
constipation
anogenital and/or vulval bleeding
changes in urinary stream
lesions of the oral cavity and/or lips

完整详情

危险因素

family history
uncircumcised state
urinary incontinence (in men/boys)
female sex

完整详情

诊断性检查

首要检查

clinical diagnosis

完整详情

需考虑的检查

skin biopsy

完整详情

新兴检查

optical coherence tomography (OCT)
high-frequency ultrasound

治疗流程

急症处理

initial presentation

持续性治疗

response to initial treatment

refractory disease

撰稿人

作者

Melissa Mauskar, MD, FAAD

Associate Professor

Department of Dermatology

Department of Obstetrics and Gynecology

UT Southwestern Medical Center

Dallas

利益声明

MM has received a grant from the Dermatology Foundation to study lichen sclerosus in postmenopausal women. MM has given lectures on lichen sclerosus.

Christina Kraus, MD, FAAD

Assistant Professor

Department of Dermatology

UC Irvine Health

Irvine

利益声明

CK is a recipient of the Dermatology Foundation Career Development Award and a consultant for Nuvig Therapeutics. CK has received consulting fees from LEO Pharma.

同行评议者

Libby (Irene Elizabeth) Edwards, MD

Director

Southeast Vulvar Clinic

Charlotte

利益声明

LE is co-author of the Genital Dermatology Manual, 1-4th edition, Wolters Kluwer, and a speaker for Symposium Medicus.

Fiona M. Lewis, MB BCh, MD, FRCP

Consultant Dermatologist

St John’s Institute of Dermatology

Guy’s & St Thomas’ Foundation Trust

London

利益声明

FML has received reimbursement for editing textbooks; has written national and international guidelines for the management of lichen sclerosus (the British Association of Dermatology, the International Union Against Sexually Transmitted Infections, and the British Association for Sexual Health and HIV); and has received reimbursement for lecturing on lichen sclerosus and vulval disease, but not from any commercial organization or for endorsing any drugs.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Simms-Cendan J, Hoover K, Marathe K, et al. NASPAG clinical opinion: diagnosis and management of lichen sclerosis in pediatric and adolescent patients. J Pediatr Adolesc Gynecol. 2022 Apr;35(2):112-20. 摘要

van der Meijden WI, Boffa MJ, Ter Harmsel B, et al. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2022 Jul;36(7):952-72.全文摘要

Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018 Apr;178(4):839-53.全文摘要

Kirtschig G, Kinberger M, Kreuter A, et al; European Dermatology Forum. EuroGuiDerm guideline on lichen sclerosus. Jun 2023 [internet publication].全文

American College of Obstericians and Gynecologists. Diagnosis and management of vulvar skin disorders: ACOG practice bulletin summary, number 224. Obstet Gynecol. 2020 Jul;136(1):222-5. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Vitiligo
- Lichen planus
- Candidiasis
更多鉴别诊断
指南
- EDF EuroGuiDerm guideline: lichen sclerosus
- NASPAG clinical opinion: diagnosis and management of lichen sclerosis in pediatric and adolescent patients
更多指南
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Lichen sclerosus

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

新兴检查

治疗流程

initial presentation

response to initial treatment

refractory disease

撰稿人

作者

Melissa Mauskar, MD, FAAD

利益声明

Christina Kraus, MD, FAAD

利益声明

同行评议者

Libby (Irene Elizabeth) Edwards, MD

利益声明

Fiona M. Lewis, MB BCh, MD, FRCP

利益声明

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

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