Lichen Sclerosus

Lichen sclerosus et atrophicus (LSA) is a cutaneous disease that has an affinity for the anogenital region. The exact etiology is unknown but there is evidence that it

Figure 9 Lichen simplex: hyperkeratosis extending from the base of mons pubis to the labia majora bilaterally. (See color insert pp. 4 and 5.)

is autoimmune in nature. There might also be a genetic component, as it can be found in mother-daughter pairs. LSA can occur at anytime through the lifespan. LSA is an intensely pruritic disease, and sleep disturbance is a common complaint with anogenital LSA.

Vulvar appearance with LSA varies depending on the severity and length of time the patient has had the condition. The disease process disrupts the normal vulvar anatomy; typical changes include phimosis of the clitoral hood, involution of the labia minora, and scarring of the introitus.

The affected skin can have a thin, white, parchment paper-like appearance, it can be thin and red, or it can be thickened and white (16). All three of these skin variations can appear on the vulvar anogenital region together. There may be an "hourglass" pattern seen over the anogenital region, which can extend into the gen-itocrural folds. A vulvar biopsy may be useful in diagnosing LSA (Figs. 10-13).

Treatment for LSA is aimed at alleviating symptoms and preventing disease progression. Low-to-moderate-potency steroid ointments are useful. There is evidence that 0.1% tacrolimus ointment (Protopic®, Astellas Pharma U.S., Inc., Deerfield, IL, U.S.A.) is useful in the treatment of LSA (17,18). Symptom management strategies include following strict vulvar skin care and hygiene guidelines, using lukewarm water baking soda or colloidal oatmeal soaks, and applying an occlusive skin protectant daily to prevent urine and vaginal discharge from contacting affected skin.

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