Lichen sclerosus is a chronic inflammatory dermatosis that results in white plaques with epidermal atrophy. Lichen sclerosus has both genital and extra genital presentations. Anyone can get lichen sclerosus, but postmenopausal women and children who have not reached puberty are at highest risk.

Signs and symptoms

• Women are more commonly affected than men, particularly around and after menopause
• The condition most commonly occurs on the vulva and around the anus with ivory-white elevations that may be flat and glistening
• In males, the disease may take the form of whitish thickening of the  penile foreskin, which cannot be retracted easily (Phimosis)
• In men, this genital involvement has traditionally been known as balanitis xerotica obliterans
•  Itching (pruritus), which can be severe
• Discomfort, which is generally greater if lichen sclerosus appears on or around your genital or anal areas
• Smooth white spots on your skin that may grow into blotchy, wrinkled patches
• Tenderness of the affected areas of your skin
• Easy bruising or tearing
• In severe cases, bleeding, blistering or ulcerated lesions
• Painful intercourse

Causes

Although it is not clear what causes lichen sclerosus, However, the condition may be related to a lack of sex hormones in the affected skin or to an overactive immune system.

Autoimmunity

In case of lichen sclerosus, specific antibodies have been found. There seems to be an higher prevalence of other autoimmune diseases such as diabetes mellitus type 1, vitiligo and thyroid disease.

Infections

Both bacterial as well as viral pathogens have been implicated, mostly by HPV, hepatitis C, spirochete infections

Hormonal status

Primarily found in women with a low estrogen state.

Local skin changes

It can be initiated through scarring or radiation

Tests and diagnosis

Removal of a small piece of affected tissue (biopsy) for examination under a microscope

Complications

• Persistent lichen sclerosus in one location may slightly increase your risk of skin cancer, although this has not yet been definitively proved.
• For this reason, make sure that you have follow-up examinations every six to 12 months
• Severe lichen sclerosus may narrow the vaginal opening and affect the ability or desire to have sexual intercourse
• The tightening and thinning of the foreskin of penis may create complications during erections or when urinating

Treatment

Asymptomatic extra genital lichen sclerosus usually requires no treatment as control of pruritus other than resolution of the lesion, which is a more realistic goal of therapy. Also, these lesions rarely itch.

Medical treatment

• Topical steroids
• Immune-modulating medications, such as tacrolimus and pimecrolimus

Surgical care

• Circumcision may benefit male lichen sclerosus and the phimosis that may accompany it.
• Vulvar surgery is not recommended unless an associated malignancy is present. Extra genital lesions may be excised but some caution should be taken as lichen sclerosus has arisen in old surgical scars.
• Cryotherapy or laser therapy (PUVA) of affected genital lesions is also reported to reduce the area involved after one or a series of treatments