Lichen Sclerosus Clinical Presentation and Diagnosis
Clinical Features
- Lichen sclerosus is a chronic inflammatory dermatosis that causes loss of labial architecture through scarring, fusion of the labia minora, and can lead to fissures and ulcerations, affecting the anogenital area in 85-98% of female patients 1, 2, 4, 5
- The disease presents with porcelain-white papules and plaques affecting the interlabial sulci, labia minora, clitoral hood, clitoris, perineal body and perineum 2, 3
- Fragile, thinned and atrophic skin with a characteristic figure-eight pattern around the vulva and anus is a common feature 1, 4, 5
- Fissures and tears develop with time, leading to pain and potential ulceration 1, 4
- Scarring causes fusion of the labia minora and narrowing of the introitus 1, 4, 5
- Areas of ecchymosis often accompany the white plaques 2, 3
Diagnostic Features
- The loss of labial distinction occurs through progressive scarring, with fusion of the labia minora eliminating the normal anatomical boundaries between structures 1, 4
- Buried clitoris results from sealing of the clitoral hood 1, 2, 3
Epidemiology
- Lichen sclerosus has a bimodal age distribution with peaks in prepubertal girls and postmenopausal women 2, 3
- The disease is more prevalent in women than men with ratios of 6:1 to 10:1 4, 5
- Most commonly presents in postmenopausal women in the fifth to sixth decade of life 4, 5
Symptoms
- Intractable pruritus is the main symptom, often worse at night 1, 2, 3, 4
- Dyspareunia occurs with erosions, fissures, or introital narrowing 1, 2, 3
- Dysuria and pain on defecation from perianal involvement 1, 4
- Some patients remain asymptomatic despite visible disease 2, 3