Lichen sclerosus

By Dr. Pascal Bafteh · last updated 09/2026

Overview

• Pathology & Epidemiology: collagen hypertrophy with atrophy of the epidermis and elastic fibers; anogenital (90–94% of cases) and extragenital (6–10%).

• Clinical presentation: porcelain-white lesions with atrophic shrinkage, sclerosis, fragile parchment-skin, pruritus; fissures parallel to the organ; Carcinoma risk higher than in LR mucosae (→ SCC risk ~4–5%).

• Complications: SCC development, strictures, phimosis, dyspareunia, micturition difficulties.

• Diagnostics: Clinical + Histology; close follow-up due to SCC risk.

• Topical 1st line: Class 4 corticosteroids (also in children!) daily for 4 weeks; steroid-sparing CNI (caution: discussed carcinogenic potential of CNI). Mometasone furoate suitable (less risk of atrophy).
• Surgical: circumcision for phimosis/extensive LSA on the penis; PDT possible (also with penile block).

• DDs LSA genitoanal: Extramammary Paget's disease, Bowen's disease, Erythroplasia of Queyrat, Zoon's balanitis plasmacellularis, Syphilis, Candidiasis, Eczema, Inverse psoriasis, Vitiligo.

Note: Guideline: EDF Guideline Lichen sclerosus (2024) Medications: Yellow List:

Differential diagnoses

• Lichen planus
• Limited systemic sclerosis (CREST syndrome)
• Steroid-induced skin atrophy
• Lichen striatus
• Psoriasis vulgaris (plaque psoriasis)
• Atopic dermatitis (atopic eczema)
• Vitiligo
• Alopecia areata

Sources (selection)

1. Bleeker et al. 2016
2. Yellow List – Mometasone furoate, Clobetasol, Pimecrolimus, Tacrolimus

More inflammatory skin diseases

• Cheilitis granulomatosa (Miescher)
• Erythema annulare centrifugum (EAC)
• Erythema nodosum
• Graft-versus-host disease (GvHD)
• Granuloma annulare
• Cutaneous sarcoidosis
• Lichen planus
• Lichenoid drug eruption

Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.