Vulvar lichen sclerosus

Clinical features

Clinical Presentation

• Definition: Lichen sclerosus is a chronic inflammatory, likely autoimmune-mediated dermatosis.
• Age of onset: The disease has two peaks of onset, namely prepubertal and postmenopausal.
• Skin findings: Typical findings are ivory-white, atrophic, cigarette paper-like skin with itching, burning and fissures.
• Distribution pattern: The characteristic distribution pattern is butterfly- or figure-of-eight-shaped around the vulva and anus.
• Loss of architecture: Advanced findings include effacement of the labia minora, fusion of the clitoral hood, synechiae and introital stenosis.
• Associations: It is frequently associated with other autoimmune diseases, especially Hashimoto's thyroiditis and vitiligo.

Diagnosis

• Establishing the diagnosis: The diagnosis is usually made clinically.
• Histology: Histologically, one finds epidermal atrophy, a broad band of homogenised collagen in the upper dermis, and an underlying lymphocytic infiltrate.

Typical imaging findings

• Clinical finding: Around the clitoris and along the labia the skin is ivory-white, thin and parchment-like; the labia minora are effaced and fused with the labia majora. The inner aspects are reddened, with small fissures and scratch marks.

Keep learning in the app

Further reading (selection)

1. StatPearls: Lichen Sclerosus (NCBI Bookshelf)
2. DocCheck Flexikon, Lichen sclerosus

Cross-references