An Overview of Lichen Sclerosus

Val, Isabel Chulvis do; Almeida, Gutemberg

doi:10.1097/01.grf.0000179635.64663.3d

Cited by 88 publications

(72 citation statements)

References 51 publications

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“…Although no association to the autoimmune-related HLA antigens (HLA A1, B8 and DR3) has been reported, the HLA class II antigen HLA DQ7 has the strongest association with LS. 2,6,13 In fact, it has been reported that 66% of a cohort of 30 children with LS had HLA DQ7, which is higher than in the control population. 13 More recently, researchers have described the coexistence of HLA B08 and HLA B18 in four siblings with LS, with a further unaffected sister not having these alleles.…”

Section: Genetic Factorsmentioning

confidence: 99%

“…More severe inflammation leads to blistering, with haemorrhagic bullae or erosions. 4,6 If left untreated, the vaginal architecture can be altered. Typically, over time, the labia minora become reabsorbed and the clitoris becomes entrapped, revealing an overall atrophic, shiny, white vulva missing normal anatomy.…”

Section: Clinical Presentation In Childrenmentioning

confidence: 99%

“…It occurs primarily in postmenopausal women, with only 5-15% of all LS cases estimated to occur in children. 2,[4][5][6] In the paediatric setting LS almost always affects the genital area, with only approximately 6% of these patients having extragenital involvement of LS. 7 The disease occurs much more frequently in females than in males, with a reported female to male ratio as high as 10 : 1.…”

Section: Epidemiologymentioning

confidence: 99%

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Paediatric vulval lichen sclerosus

Smith

Fischer

2009

Aust J Dermatology

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Lichen sclerosus (LS) in children is uncommon; however, it is an important differential diagnosis in any pre-pubertal child presenting with chronic vulval symptoms. The long-term prognosis is unknown; however, recent data suggests that the assumption that the condition will resolve at puberty may be incorrect. Children with LS require long-term management with topical corticosteroids, which remains the treatment of choice, as well as long-term follow up. We review the current literature on paediatric vulval LS.

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Section: Genetic Factorsmentioning

confidence: 99%

Section: Clinical Presentation In Childrenmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

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Paediatric vulval lichen sclerosus

Smith

Fischer

2009

Aust J Dermatology

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“…The Köbner phenomen can occur in lichen sclerosis, whereby lesions develop at sites of trauma, constant friction or old scars. 2,3 Although radiation therapy causes trauma to skin, few instances of lichen sclerosus occurring several years after radiation therapy for breast cancer have been reported. 4 In our patient, the lichen sclerosus at the site of radiation was likely the result of the Köbner phenomenon.…”

mentioning

confidence: 99%

“…1 The mainstay of treatment is high-potency topical corticosteroids, which have shown good clinical response in various studies. 3 Other treatment options include topical testosterone or progesterone, topical or oral retinoids, and surgery. This article has been peer reviewed.…”

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confidence: 99%

Lichen sclerosus in a radiated breast

Vujovic

2010

Canadian Medical Association Journal

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A 77-year-old woman with cancer of the left breast (T2N0M0) had undergone breast-conserving surgery and had received adjuvant hormonal treatment with anastrozole and radiation therapy. She had had a good cosmetic outcome with no discernable skin changes or breast pain. Two years after completion of the radiation treatments, severe discomfort developed in her left breast. The discomfort was associated with ivory-white patches with overlying telangiectasia and purpuric hemorrhages not seen with radiation dermatitis. A biopsy of the left breast confirmed lichen sclerosus. Treatment with betamethasone 0.05% cream re sulted in some improvement (Figure 1). However, after six months, she still had pain and skin changes of the breast and elected to undergo a left mastectomy. Histopathology of skin from the breast is shown in Appendix 1 (available at www .cmaj .ca /cgi /content /full /cmaj.091800/DC1).Lichen sclerosus usually occurs in women over the age of 50 and involves the anogenital area in 85% of affected patients.1 The most common extragenital sites are the neck, shoulders, upper back and chest. The exact cause of lichen sclerosus is not known, but it is associated with several autoimmune disorders, including alopecia areata and vitiligo. The Köbner phenomen can occur in lichen sclerosis, whereby lesions develop at sites of trauma, constant friction or old scars.2,3 Although radiation therapy causes trauma to skin, few instances of lichen sclerosus occurring several years after radiation therapy for breast cancer have been reported. 4 In our patient, the lichen sclerosus at the site of radiation was likely the result of the Köbner phenomenon.Although genital lichen sclerosus is associated with a small risk of squamous cell carcinoma (5%), either vulvar or penile, the extragenital form is not. The mainstay of treatment is high-potency topical corticosteroids, which have shown good clinical response in various studies.3 Other treatment options include topical testosterone or progesterone, topical or oral retinoids, and surgery. This article has been peer reviewed.Competing interests: None declared. Clinical images are chosen because they are particularly intriguing, classic or dramatic. Submissions of clear, appropriately labelled high-resolution images must be accompanied by a figure caption and the patient's written consent for publication. A brief explanation (300 words maximum) of the educational significance of the images with minimal references is required.

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