Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.

/pdf/diagnosis-and-treatment-of-lichen-sclerosus-an-update-4ztlg5fas4.pdf

Diagnosis and Treatment of Lichen Sclerosus: An Update

This is an updated guideline prepared for the British Association of Dermatologists’ (BAD) Clinical Standards Unit, made up of the Therapy & Guidelines Subcommittee (T&G) and the Audit & Clinical Standards Subcommittee (A&CS). Members of the Clinical Standards Unit are: M.J. Tidman (Chairman T&G), L.C. Fuller (Chairman A&CS), N.J. Levell, P.D. Yesudian, J. Lear, J. Hughes, A.J. McDonagh, S. Punjabi, N. Morar, S. Wagle (British National Formulary), S.E. Hulley (British Dermatological Nursing Group), K.J. Lyons (BAD Scientific Administrator) and M.F. Mohd Mustapa (BAD Clinical Standards Manager).

/pdf/british-association-of-dermatologists-guidelines-for-the-4hvp0egmte.pdf

British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010.

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of lichen sclerosus (LS) in adults (18+ years), children (0-12 years) and young people (13-17 years). The document aims to. offer an appraisal of all relevant literature up to July 2017, focusing on any key developments. address important, practical clinical questions relating to the primary guideline objective. provide guideline recommendations and if appropriate research recommendations. The guideline is presented as a detailed review with highlighted recommendations for practical use in primary care and in secondary care clinics, in addition to an updated Patient Information Leaflet (PIL; available on the BAD website, http://www.bad.org.uk/for-the-public/patient-information-leaflets). This article is protected by copyright. All rights reserved.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjd.16241

British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018

Summary These guidelines for the management of lichen sclerosus have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

https://www.bad.org.uk/library-media/documents/Lichen%20sclerosus%202002.pdf

Guidelines for the management of lichen sclerosus.

Lichen sclerosus is a relatively common chronic inflammatory skin disease that predominantly affects the anogenital area. Accumulating evidence indicates that lichen sclerosus in women may be associated with other autoimmune disease, whereas this association seems to lack in male patients. We retrospectively evaluated the prevalence of autoimmune diseases and serological parameters indicative for autoimmunity in male and female patients with lichen sclerosus. Of the 532 patients (396 women, 136 men; 500 adults, 32 children; mean age: 49 years; range 1-89 years; female:male ratio 3:1), 452 (85%) had genital and 80 (15%) had extragenital disease. In women, lichen sclerosus was significantly more often associated with at least one autoimmune disease as compared to men (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.9-9.6; p<0.0001). Moreover, female patients with lichen sclerosus had sinificantly more often associated autoimmune thyroid diseases (OR 4.7, 95% CI 1.8-11.9; p<0.0002), antithyroid-antibodies (OR 2.7, 95% CI 1.1-6.5; p=0.023), and elevated autoantibodies (OR 4.1, 95% CI 1.9-9.3; p<0.0001) as compared to male patients. This observation is suggestive for a different pathogenetic background in male and female patients.

/pdf/association-of-autoimmune-diseases-with-lichen-sclerosus-in-55gfq3ppfu.pdf

Association of autoimmune diseases with lichen sclerosus in 532 male and female patients.

Lichen sclerosus is a chronic skin condition with a predilection for the genital area. In the present study, 35 male patients with lichen sclerosus were interviewed and examined. Blood screens were performed and histology was requested if not already performed. The findings indicate that lichen sclerosus in males exists as a spectrum of disease, ranging from a mild form with white plaques and few symptoms to a severe form with inflammation, atrophy and scarring with possible urological consequences. In many areas it differs from the condition in females; the association with autoimmune disease is weaker and there is less perianal and extragenital involvement. The association with malignancy in males is of lesser significance than initially believed.

A study of clinical and aetiological factors and possible associations of lichen sclerosus in males

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A study of clinical and aetiological factors and possible associations of lichen sclerosus in males