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
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
Risk factors
- family history
- uncircumcised state
- urinary incontinence (in men/boys)
- female sex
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- skin biopsy
Emerging tests
- optical coherence tomography (OCT)
- high-frequency ultrasound
Treatment algorithm
initial presentation
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.
Differentials
- Vitiligo
- Lichen planus
- Candidiasis
More DifferentialsGuidelines
- EDF EuroGuiDerm guideline: lichen sclerosus
- NASPAG clinical opinion: diagnosis and management of lichen sclerosis in pediatric and adolescent patients
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