Derm Dx: Discolored patches on the torso of a woman with vulvar lichen sclerosus - Clinical Advisor

Derm Dx: Discolored patches on the torso of a woman with vulvar lichen sclerosus

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A 62-year-old woman is referred to the office with biopsy-confirmed lichen sclerosus of the vulvar region that had been present for 18 months. Currently, she is being treated with topical clobetasol ointment, but she continues to experience localized pain and burning. Examination of the genital area reveals classic white plaques. Discolored patches with central telangiectasias are also noted on her abdomen and chest. 

Lichen sclerosus is an inflammatory disorder of unknown etiology that is characterized by whitish patches and plaques accompanied by atrophy and scarring. The condition has a marked female predominance and affects all races.1Examination by dermoscopy or confocal microscopy reveals atrophy...

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Lichen sclerosus is an inflammatory disorder of unknown etiology that is characterized by whitish patches and plaques accompanied by atrophy and scarring. The condition has a marked female predominance and affects all races.1

Examination by dermoscopy or confocal microscopy reveals atrophy of the epidermis and follicular plugging and fibrosis of the dermis.2 The vulva is the most commonly affected site, and localized itching and burning are frequent complaints. An underlying autoimmune pathogenesis for lichen sclerosus has been postulated.3

Extragenital lichen sclerosus occurs in approximately 15% of cases and is usually asymptomatic. Affected areas are porcelain and atrophic in appearance and over time, telangiectasias may develop.

Treatment for extragenital lichen sclerosus is similar to treatment for genital lichen sclerosus. Potent topical steroids and calcineurin inhibitors may induce remission, but usually long-term therapy is required.4,5 Unlike genital disease, extragenital lichen sclerosus is not associated with malignant transformation.

Stephen Schleicher, MD, is an associate professor of medicine at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine of the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet. 1999;353:1777-1783.
  2. Lacarrubba F, Pellacani G, Verzì AE, Pippione M, Micali G. Extragenital lichen sclerosus: clinical, dermoscopic, confocal microscopy and histologic correlations. J Am Acad Dermatol. 2015;72(1 Suppl):S50-S52.
  3. Neill SM, Lewis FM, Tatnall FM, Cox NH; British Association of Dermatologists. British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010. Br J Dermatol. 2010;163:672-682.
  4. Welsh BM, Berzins KN, Cook KA, Fairley CK. Management of common vulval conditions. Med J Aust. 2003;178:391-395.
  5. Kreuter A, Gambichler T, Sauermann K, Jansen T, Altmeyer P, Hoffmann K. Extragenital lichen sclerosus successfully treated with topical calcipotriol: evaluation by in vivo confocal laser scanning microscopy. Br J Dermatol. 2002;146:332-333.
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