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Lichen sclerosus

Last reviewed: 3 Sep 2024
Last updated: 12 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • 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
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • skin biopsy
Full details

Emerging tests

  • optical coherence tomography (OCT)
  • high-frequency ultrasound

Treatment algorithm

ACUTE

initial presentation

ONGOING

response to initial treatment

refractory disease

Contributors

Authors

Melissa Mauskar, MD, FAAD

​Associate Professor

Department of Dermatology

Department of Obstetrics and Gynecology

UT Southwestern Medical Center

Dallas

TX

Disclosures

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

CA

Disclosures

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.

Peer reviewers

Libby (Irene Elizabeth) Edwards, MD

​Director

Southeast Vulvar Clinic

Charlotte

NC

Disclosures

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

UK

Disclosures

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.

  • Lichen sclerosus images
  • Differentials

    • Vitiligo
    • Lichen planus
    • Candidiasis
    More Differentials
  • Guidelines

    • EDF EuroGuiDerm guideline: lichen sclerosus
    • NASPAG clinical opinion: diagnosis and management of lichen sclerosis in pediatric and adolescent patients
    More Guidelines
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