Lichen sclerosus vulvae

Vulvar lichen sclerosus (LS) is a chronic inflammatory skin disease which typically affects postmenopausal women but can occur in all age groups including children. The etiology of LS remain unknown, but there seems to be a genetic component and a link with autoimmune diseases. Infectious mechanism, trauma and injury may trigger LS in susceptible patients. Although LS can occur without symptoms or with mild erythema and petechiae only, it usually causes substantial discomfort with intractable pruritus and soreness. Progression to destructive scarring and atrophy is rather common. In children, the disorder may be confused with changes seen in sexual abuse. There is also an increased risk of developing a squamous cell carcinoma in longstanding vulvar LS with squamous hyperplasia. Treatment of choice is potent topical glucocorticoid ointment for a limited time. Early adequate treatment results in remission and prevents progression to atrophy and scarring. Surgical treatment may be considered to relieve effects of scarring and treat a co-existing squamous cell carcinoma.