Lichen sclerosus

Lichen sclerosus is a skin condition affecting all areas of the body at all ages and in both sexes. It appears to be a histologic and clinical entity, although in very many respects it is close to lichen planus and morphea. Its cause and pathogenesis are not established, but a link with autoimmune disease is recognized. Its predilection for the anogenital area in women has led to an unfortunate dichotomy between dermatologists and gynecologists. This was a potent source of confusion for many years but has now been resolved with a the recent formulation of a classification acceptable to the ISSVD (representing gynecologists, dermatologists, and pathologists) and the ISGyP (see Appendices). It is hoped that management will now be more logical, with the mainstay being emollients and topical corticosteroids, and that the vulvectomies sometimes performed for benign disease have become a thing of the past. There is almost certainly an increased risk of malignancy in lichen sclerosus, albeit at present an unquantifiable one, and for that reason patients should be kept under review.