Lichen sclerosus

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Última revisão: 21 Aug 2025

Última atualização: 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.

Definição

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]

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

skin biopsy

Detalhes completos

Novos exames

optical coherence tomography (OCT)
high-frequency ultrasound

Algoritmo de tratamento

AGUDA

initial presentation

CONTÍNUA

response to initial treatment

refractory disease

Colaboradores

Autores

Melissa Mauskar, MD, FAAD

Associate Professor

Department of Dermatology

Department of Obstetrics and Gynecology

UT Southwestern Medical Center

Dallas

Declarações

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

Declarações

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.

Revisores

Libby (Irene Elizabeth) Edwards, MD

Director

Southeast Vulvar Clinic

Charlotte

Declarações

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

Declarações

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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. Resumo

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.Texto completo Resumo

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.Texto completo Resumo

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

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. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Vitiligo
- Lichen planus
- Candidiasis
Mais Diagnósticos diferenciais
Diretrizes
- EDF EuroGuiDerm guideline: lichen sclerosus
- NASPAG clinical opinion: diagnosis and management of lichen sclerosis in pediatric and adolescent patients
Mais Diretrizes
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Lichen sclerosus

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

initial presentation

response to initial treatment

refractory disease

Colaboradores

Autores

Melissa Mauskar, MD, FAAD

Declarações

Christina Kraus, MD, FAAD

Declarações

Revisores

Libby (Irene Elizabeth) Edwards, MD

Declarações

Fiona M. Lewis, MB BCh, MD, FRCP

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice