Genital lichen planus: update on diagnosis and treatment

Lichen planus (LP) is an inflammatory autoimmune disease that affects both glabrous and mucosal skin. Although pathophysiology has not yet been fully defined, LP is a T-cell mediated disorder that demonstrates an increased Th1 cytokine expression as well as T-cell reactivity against basement membrane zone components. In males, genital LP often takes its more classic form as pink, shiny, flat-topped papules on the glans and coronal sulcus. In women, erosive disease is most common and often leads to significant scarring and sexual dysfunction. Therapeutic management is challenging, and control rather than cure is the goal. Topical corticosteroids remain first-line therapy, but some women will require systemic immunosuppressants to achieve remission. Surgery is less common for women with significant scarring who wish to resume sexual activity. Further research is needed on pathogenesis, and randomized controlled trials are necessary to better define best treatments for this chronic disease.