Female genital lichen sclerosus

Female genital lichen sclerosus (FGLSc) is a chronic inflammatory scarring dermatosis that can lead to scarring and irreversible architectural change, sexual and urological dysfunction and malignancy. Although the aetiology is not completely understood, current evidence supports a multifactorial pathogenesis involving immune dysregulation, genetic susceptibility, epithelial stress and aberrant fibrogenesis, with emerging evidence for chronic irritation and occluded exposure to urine in susceptible individuals. Clinically, FGLSc presents with pruritus, soreness, dyspareunia and progressive scarring. Long-standing disease may result in labial resorption, clitoral phimosis, introital narrowing and consequent functional impairment. There is a well-recognized association between FGLSc and differentiated vulval intraepithelial neoplasia (dVIN) and vulval squamous cell carcinoma (SCC), with chronic inflammation thought to contribute to carcinogenesis. Management aims to control inflammation, restore epithelial barrier function and reduce occlusive exposure to urine. Ultrapotent topical corticosteroids remain first-line therapy, supported by avoidance of irritants, protection with barrier emollient, treatment of urinary incontinence and psychosexual support where required. Additional medical and surgical treatments may be required in refractory or complicated disease. Emerging targeted therapies, such as Janus kinase (JAK) inhibitors, may have a role in selected cases of refractory disease, although trial data remain limited. This review summarizes current knowledge on the clinical presentation, pathogenesis, malignant potential and management of FGLSc and highlights emerging concepts in diagnosis, monitoring and disease-modifying therapy.