Materiały źródłowe

• #1 Lichen Sclerosus—Presentation, Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4904529/

  Lichen sclerosus is a chronic inflammatory skin disease. It is thought to be underdiagnosed and undertreated. If it is not treated, lichen sclerosus is associated with a greater degree of scarring and an elevated risk of cancer in the genital area. […] Anogenital itching and clinical features such as erythema, white skin changes (such as hyperkeratosis and sclerosis), and fissures should arouse suspicion of lichen sclerosus. The diagnosis should be confirmed with a skin biopsy, and early, thorough treatment should be initiated. In this way, a mutilating disease course can be averted, and the risk of cancer can be lessened. […] For the experienced examiner the clinical picture is often diagnostic and histological evidence is not mandatory. Whitish alterations of the skin in the anogenital area paired with itching point to lichen sclerosus. When the clinical picture is unclear or the physician is not familiar with the disease, a biopsy from a typical lesion should be performed.

• #1 Lichen Sclerosus: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16564-lichen-sclerosus

  Lichen sclerosus is a chronic inflammatory condition that affects skin on your genitals. […] Healthcare providers will diagnose lichen sclerosus. Theyll ask questions about your symptoms and perform a physical examination, which includes an evaluation of your affected areas. […] To confirm their lichen sclerosus diagnosis, your healthcare provider may perform a biopsy. […] Yes, healthcare providers can treat lichen sclerosus without circumcision. Circumcision can sometimes treat lichen sclerosus, but there are other options. […] An essential part of lichen sclerosus treatment includes regular checkups with a healthcare provider. Theyll watch for signs of skin cancer and help prevent scarring around your genitals. […] The sooner a healthcare provider can diagnose lichen sclerosus and provide treatment, the better the outlook. However, even with early diagnosis and treatment, symptoms may appear randomly for the rest of your life.

• #1

  https://link.springer.com/article/10.1007/s40257-012-0006-4

  Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. […] Therefore, early diagnosis, prompt treatment, and long-term follow-up of affected patients are mandatory. […] Since LS begins with uncharacteristic symptoms, a meticulous clinical examination, raising the clinical suspicion and, if necessary, a histopathologic confirmation is required. […] The diagnosis of LS is usually clinical. When the clinical features are typical, histologic examination is not always essential. However, in the early stages of the disease the diagnosis can be difficult. […] In clinically inconclusive cases, a histologic examination is advisable and might close the gap, but should never be interpreted in isolation. […] A nonspecific biopsy does not rule out LS, but classic histologic findings confirm the diagnosis.

• #1 Lichen sclerosus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lichen-sclerosus/diagnosis-treatment/drc-20374452

  Your health care provider may diagnose lichen sclerosus by looking at the affected skin. You may need a biopsy to rule out cancer. You may need a biopsy if your skin doesn’t respond to steroid creams. A biopsy involves removing a small piece of affected tissue for examination under a microscope. […] You may be referred to specialists in skin conditions (dermatologist), the female reproductive system (gynecologist), urology and pain medicine. […] If you have symptoms of lichen sclerosus, make an appointment with your health care provider. You may be referred to a specialist in the diagnosis and treatment of skin conditions (dermatologist).

• #1

  https://link.springer.com/article/10.1007/s40257-012-0006-4

  Patients under routine follow-up will need a biopsy if: (1) there is a suspicion of neoplastic change, i.e., a persistent area of hyperkeratosis, persistent erosion, or erythema, or new warty or papular lesions; (2) there is an area resistant to adequate treatment; (3) there is extragenital LS, with features suggesting an overlap with morphea; (4) there are pigmented areas, in order to exclude an abnormal melanocytic proliferation; and (5) second-line therapy is to be used. […] The pathology for LS is far from being always conclusive. Thus, for the final diagnosis, the clinicopathologic correlation is pivotal.

• #1 Lichen Sclerosus—Presentation, Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4904529/

  A biopsy is usually taken under local anesthesia and is generally well tolerated. […] When the clinical and histological findings differ, repeated examinations must be performed: e.g., a repeat biopsy to ensure the diagnosis. […] The Table describes differential diagnoses of lichen sclerosus. Prolonged, unspecific treatment, e.g., for supposed candidiasis ought to be avoided. […] A typical whitish alteration of healthy-appearing skin should be biopsied, not ulcerations or fissures (5 mm punch biopsy). Only older lesions usually exhibit typical characteristics of lichen sclerosus, early lesions may be unspecific.

• #1 Lichen Sclerosus | Doctor

  https://patient.info/doctor/lichen-sclerosus-pro

  Diagnosing lichen sclerosus (investigations)15 […] The diagnosis is usually made clinically. In primary care, if the clinician is not confident in identification and management, referral should be made to a primary care colleague with a special interest or to secondary care (usually a specialist vulval dermatology clinic or urology clinic in men). Lesions should be well documented for follow-up purposes, ideally with diagrams or photography. Other investigations may include: […] Biopsy: […] Is indicated only when there is diagnostic uncertainty or suspected malignancy. […] Should be considered where presentation is atypical – for example, in young adult women, in extragenital lesions or pigmented lesions. […] Is not always practical – eg, in children. It may be preferable to start treatment and to monitor response.

• #1 Lichen sclerosus: An overview – Medical Independent

  https://www.medicalindependent.ie/clinical-news/lichen-sclerosus-an-overview/

  Lichen sclerosus is a chronic, inflammatory skin condition that primarily affects the genital and perianal regions. […] Diagnosis of lichen sclerosus is clinical, based on a careful medical history including autoimmune diseases in the patient and family, examination of the mucosas, extragenital skin and a gynaecological exam. Workup should include investigation of thyroid function, and according to symptoms, investigation of other autoimmune diseases. […] Due to lichen sclerosus resemblance to other dermatological conditions such as lichen planus and other inflammatory skin disorders, a biopsy may be necessary for confirmation. Biopsies should be performed in case of atypical clinical presentation; suspected malignancy; and non-response to recommended first-line treatment. Histopathological examination reveals epidermal atrophy, sclerosis, hyalinisation, and a lymphocytic inflammatory infiltrate.

• #1 Lichen Sclerosus – Vulvovaginal Disorders

  https://vulvovaginaldisorders.org/atlas_topic/lichen-sclerosus/

  Lichen sclerosus (LS) is a chronic inflammatory skin disorder primarily of the anogenital areas but also the general skin (6-20%). It rarely affects mucous membranes. LS results in inflammation, marked hypopigmentation, tissue thinning, areas of thickening and hyperplasia and scarring. […] Diagnosis is made based on the clinical pattern and histopathology. […] Contrary to many references in texts and atlases, in the early stages of LS both the clinical appearance and the histologic picture from biopsy may be difficult to interpret. Features may be similar to psoriasis or lichen planus: irregular acanthosis, mild hyperkeratosis, hypergranulosis, mild lichenoid lymphocytic infiltrate with lymphocyte tagging and dilated blood vessels immediately under the basement membrane, focal basement membrane thickening, luminal hyperkeratosis of adnexal structures, submucosal edema and homogenization, lymphocyte exocytosis.

• #1 Lichen Sclerosus – Vulvovaginal Disorders

  https://vulvovaginaldisorders.org/atlas_topic/lichen-sclerosus/

  Therefore, considerable clinical judgment combined with biopsy findings must be united for diagnosis. Biopsy may not be helpful if a potent topical steroid has been used within the last two to four weeks since hyalinization of lichen sclerosus is lost. […] A nonspecific biopsy does not rule out lichen sclerosus, although classic histologic findings confirm the diagnosis. […] Differential diagnosis includes inflammatory disease (vitiligo, morphea), erosive disease (lichen planus, cicatricial pemphigoid, pemphigus vulgaris), infection (condyloma, herpes simplex virus), neoplasia (dVIN or HSIL, VSCC, extra-mammary Paget disease) and primary dermatoses (eczematous, allergic or irritant contact dermatitis), lichen simplex chronicus, and papulosquamous disease (seborrheic dermatitis, inverse psoriasis). Also in the differential are post-menopausal atrophy, and sexual abuse (in children).

• #1 Diagnosis, referrals, check-ups and support | Lichen Sclerosus Guide

  https://www.lichensclerosusguide.org.uk/diagnosis-check-ups/

  Whatever signs and symptoms you’re experiencing, if you think you might have vulval lichen sclerosus (LS), the first step to feeling better is getting a proper diagnosis and treatment plan. […] The most important thing is that the person you go to listens and tries to help, whether that’s by making a diagnosis themselves, or referring you on to a specialist. […] To diagnose LS, your doctor will need to examine you. It’s the only way to be certain about a diagnosis, and to make sure you get the treatment you need. […] Sometimes people need a biopsy to confirm their LS diagnosis. If your doctor says you need one, you can find out what to expect in our biopsy information. […] We know that LS is often misdiagnosed, most commonly as thrush (a yeast infection) or as a symptom of menopause. That’s why it’s so important to have an examination.

• #1 Lichen Sclerosus | Doctor

  https://patient.info/doctor/lichen-sclerosus-pro

  Is essential if lesions do not respond to adequate treatment. […] Swabs are not required routinely but may be necessary in cases where there is erosive disease to exclude infection such as candidiasis or herpes simplex. […] Blood tests: current evidence and guidelines advise that an autoantibody screen to look for associated autoimmune disease is useful only if there are clinical features to suggest an autoimmune disorder. Consider autoimmunity screen and thyroid function tests if symptoms are present. There is no evidence to support testing for autoantibodies without a clinical indication. […] […] […] Management of lichen sclerosus15 […] Where should patients be treated and followed up? […] LS can be managed by a GP, dermatologist or gynaecologist, depending on local expertise and protocols. Referral may be required to confirm the diagnosis.

• #1 Frontiers | Lichen sclerosus: The 2023 update

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1106318/full

  Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. […] The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. […] The established diagnosis of LS based on the clinical features is usually sufficient, and a skin biopsy should only be performed in case of clinical doubts, differential diagnosis or suspected malignancy. […] The diagnosis of LS in adults and children is typically clinical, involving a thorough medical history and physical examination. […] Histopathological assessment is mostly not necessary, as the clinical picture can be enough for the diagnosis. Nevertheless, there are many situations where an histological examination should always be considered. […] Dermoscopy is a useful tool to support the non-invasive diagnosis of LS as well as to optimize the biopsy site. […] The reflectance confocal microscopy is another non-invasive technique for imaging skin in vivo.

• #1 Lichen sclerosus – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000340

  Lichen sclerosus (LS, also known as balanitis xerotica obliterans in men) is an inflammatory skin condition with a chronic relapsing and remitting course. […] Diagnosis is predominantly clinical, but confirmation by biopsy is recommended if there is diagnostic uncertainty or suspicion of malignancy. […] 1st tests to order: clinical diagnosis. […] Tests to consider: skin biopsy. […] Emerging tests: optical coherence tomography (OCT), high-frequency ultrasound.

• #1 Vulval lichen sclerosus – diagnosis and treatment | Medicine Today

  https://medicinetoday.com.au/mt/2019/january/feature-article/vulval-lichen-sclerosus-%E2%80%93-diagnosis-and-treatment

  Vulval lichen sclerosus (VLS) is an important condition to diagnose correctly and manage actively for two reasons. First, if not treated aggressively it may significantly scar, shrink and deform the vulva and cause stenosis of the introitus with a resultant impact on quality of life. Second, it is a risk factor for malignant squamous cell neoplasia of the vulva with a lifetime risk in untreated or inadequately treated disease of 2 to 6%. […] The definitive diagnostic test for LS is a skin biopsy, which should be taken from the most densely white area. The histopathological characteristics are distinctive and uniform across all ages. […] Although VLS has a characteristic clinical appearance, a skin biopsy taken from the affected site at first presentation provides diagnostic confirmation and exclusion of alternative diagnoses. A positive biopsy result is also helpful in counselling the patient about the important long-term consequences and the need for follow up, and useful if the patient changes location or medical practitioner. […] In children, a clinical diagnosis is almost always sufficient because biopsy is traumatic, the list of possible differential diagnoses is small and neoplastic transformation has never been reported to occur in children with VLS.

• #1

  https://ugeskriftet.dk/dmj/childhood-lichen-sclerosus-rare-important-diagnosis

  The clinical history and appearance of the lesions are usually very characteristic. A biopsy is rarely needed in children, unless atypical or neoplastic changes are suspected or if the disease fails to respond to adequate therapy. […] In conclusion, anogenital LS in children is a rare diagnosis mostly seen in girls. To avoid diagnostic delay, symptoms of anogenital pruritus, bleeding, dysuria and obstipation should lead to an examination of the anogenital skin and LS should be considered, also in prepubertal children. If children have persistent anogenital complaints or skin changes despite medical treatment, they should be referred to a dermatologist. Delay in diagnosis and treatment can lead to severe scarring of the anogenital area. Potent corticosteroids are very effective in treatment of this disease.

• #1 Patient education: Vulvar lichen sclerosus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/vulvar-lichen-sclerosus-beyond-the-basics

  Lichen sclerosus (LS) is a skin disorder that causes the skin to become thin, whitened, and wrinkled and can cause itching or pain. […] Providers typically use the following methods to diagnose vulvar lichen sclerosus (LS). […] A medical history and physical examination of the vulvar and anal areas will be done, looking for the signs and symptoms of vulvar LS. […] A skin biopsy can be taken to confirm a suspected diagnosis of vulvar LS; however, this is not always required. […] An examination or tests may be done to exclude other conditions that could cause symptoms similar to those of vulvar LS, such as: […] Diagnosing vulvar LS early, treating it effectively, and biopsying any abnormal areas may help to reduce the risk of developing or missing a diagnosis of skin cancer. […] A once-yearly examination of the skin of the vulva is recommended, and women should examine themselves regularly (for example, monthly) for lumps or sores that do not heal. […] A biopsy should be performed if there are areas that do not improve with treatment.

• #1 Lichen sclerosus

  https://www.nhs.uk/conditions/lichen-sclerosus/

  Lichen sclerosus affects people of all ages, including children. But it’s much more common in women over 50. […] A GP may refer you to a specialist for tests and treatment. […] Lichen sclerosus cannot be cured, but using a strong prescription steroid ointment usually helps relieve the symptoms. […] You may need to use the ointment regularly for a few months to get your symptoms under control. […] Follow your doctor’s advice about how and when to use any medicine that’s prescribed for you. […] Although treatment for lichen sclerosus can help, the affected skin can sometimes become scarred and tight over time. […] If lichen sclerosus is severe, you might need a small operation, such as surgery to widen your vagina or remove your foreskin (circumcision). […] Lichen sclerosus increases your risk of getting cancer on your vulva, penis or anus. […] The risk is low, but it’s a good idea to check yourself regularly and see a GP if you’re worried. […] Symptoms to look for include a lump, a change in skin texture, such as thickening, or an ulcer that does not go away.

• #1 Patient education: Vulvar lichen sclerosus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/vulvar-lichen-sclerosus-beyond-the-basics/print

  Diagnosing vulvar LS early, treating it effectively, and biopsying any abnormal areas may help to reduce the risk of developing or missing a diagnosis of skin cancer. […] A biopsy should be performed if there are areas that do not improve with treatment. […] The good news for patients who have been diagnosed with vulvar lichen sclerosus (LS) is that treatments such as topical steroid ointments are very effective. Thus, early treatment of vulvar LS with topical steroids can prevent scarring. Follow-up is important throughout the patient’s lifetime.

• #1 Lichen sclerosus (syn. lichen sclerosus et atrophicus)

  https://www.pcds.org.uk/clinical-guidance/lichen-sclerosis

  LS can develop after an injury to the affected area (the Koebner phenomenon) […] In many cases the diagnosis is clinical, however, if a biopsy is needed the characteristic feature is a band of hyalinization of the dermal collagen below the epidermis […] Most adults with uncomplicated lichen sclerosus can be managed in Primary Care, but if the diagnosis is in doubt the patient should be referred to Secondary Care. Children should be referred to Secondary Care from the onset […] The mainstay of treatment is that of Dermovate cream / ointment (Clobetasol proprionate) […] Long-term follow-up in Secondary Care is appropriate for patients with genital LS associated with troublesome symptoms, localised skin thickening (associated with a higher risk of malignant change), or VIN […] Written instruction should be given to the patient at the time of their discharge from the clinic warning them that any persistent area of well-defined erythema, bleeding/ulceration, or skin thickening/lump must be reported to their family practitioner straight away, who will then make an urgent referral back to an appropriate specialist, as such an occurrence could represent malignant transformation.

• #1 Lichen Sclerosus | Doctor

  https://patient.info/doctor/lichen-sclerosus-pro

  Specialist advice on treatment may be needed – eg, if a woman does not appear to respond to treatment. Men with urinary symptoms should be referred to a urologist. Vulval clinics and urology clinics have a role, particularly if there are complications. […] Long-term follow-up is needed for women with LS, particularly for patients on long-term steroids and with poorly controlled LS. […] Patients who respond well to treatment and need only small amounts of topical steroids should be reviewed annually – this can be in primary care. Give patients clear instructions to report immediately any persistent new lumps, skin changes, erosions or ulcers. […] […] […] The current evidence demonstrates the efficacy of clobetasol propionate, mometasone furoate, and pimecrolimus in treating genital lichen sclerosus.6 Clobetasol has been demonstrated to be more effective than pimecrolimus.78

• #1 Early diagnosis of lichen sclerosus et atrophicus often proves difficult

  https://www.dermatologytimes.com/view/early-diagnosis-lichen-sclerosus-et-atrophicus-often-proves-difficult

  What youre looking for clinically is subtle, early signs of skin thinning or sclerosis. […] Because patients will generally consult an OB/GYN when her symptoms occur, the condition often is first diagnosed by that specialist, who may then begin treatment. […] Dr. Bangert says it is important for physicians to keep LS in mind when symptoms are first reported, because when LS clinical changes of the skin become more severe, they arent easily returned to a pristine state. […] If the condition is identified early enough, the patient may not have any permanent changes. If, however, treatment begins later, there will probably not be a complete normalization of the anatomy, although the symptoms can be controlled, she says.

• #1 Lichen sclerosus – Wikipedia

  https://en.wikipedia.org/wiki/Lichen_sclerosus

  The disease often goes undiagnosed for several years, because it is sometimes not recognized, and misdiagnosed as thrush or other problems, and not correctly diagnosed until the patient is referred to a specialist after the problem does not clear up. […] A biopsy of the affected skin can be done to confirm a diagnosis. When a biopsy is done, hyperkeratosis, atrophic epidermis, sclerosis of dermis and lymphocyte activity in dermis are histological findings associated with LS. […] It has been noted that clinical diagnosis of balanitis xerotica obliterans can be „almost unmistakable,” though there are other dermatologic conditions such as lichen planus, localized scleroderma, leukoplakia, vitiligo, and the cutaneous rash of Lyme disease can have a similar appearance.

• #1 What Kind of Doctor Treats Lichen Sclerosus? – Coyle Institute

  https://coyleinstitute.com/doctors-lichen-sclerosus/

  Lichen sclerosus is a chronic, uncommon condition that causes thin, white patches of skin, usually in the genital area. […] For women, it is sometimes diagnosed in the gynecologists office through visual examination, but biopsy may be needed to diagnose difficult cases or to confirm the diagnosis. […] Consultations with the following specialists may be helpful for lichen sclerosus diagnosis and treatment: Gynecologist if dysplasia or malignancy are identified or suspected on biopsy, ulcerated areas should be examined repeatedly and frequently by a gynecologist. […] Urogynecologist if pelvic organ functions, pelvic floor health and surrounding tissues and muscles that support pelvic organs are affected by lichen sclerosus. […] Even though lichen sclerosus is currently incurable, women can be relieved of all signs and symptoms of it with just one TULIP treatment.

• #1 Diagnosis, referrals, check-ups and support | Lichen Sclerosus Guide

  https://www.lichensclerosusguide.org.uk/diagnosis-check-ups/

  Many GPs, practice nurses and sexual health practitioners have the knowledge and experience to diagnose and look after LS themselves. But in some cases they might feel it’s best to refer you to a specialist (often a dermatologist or gynaecologist). […] It’s not always easy to diagnose LS, so sometimes doctors ask for a biopsy to make sure. This isn’t the case for everyone, but there’s a chance it could happen to you. […] In a lot of cases, vulval lichen sclerosus (LS) can be diagnosed by your doctor, based on an examination and a conversation about your symptoms. However, for a small number of people, the signs can be less clear, and a biopsy might be recommended to make sure LS is the right diagnosis. […] A vulval biopsy involves taking a small sample of skin from your vulva, after numbing the area with a local anaesthetic. You’ll be awake while this happens, and the whole appointment usually only takes 20 to 30 minutes.

• #1 Patient education: Vulvar lichen sclerosus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/vulvar-lichen-sclerosus-beyond-the-basics/print

  Lichen sclerosus (LS) is a skin disorder that causes the skin to become thin, whitened, and wrinkled and can cause itching or pain. […] Providers typically use the following methods to diagnose vulvar lichen sclerosus (LS). […] A medical history and physical examination of the vulvar and anal areas will be done, looking for the signs and symptoms of vulvar LS. A general skin examination may also be performed to exclude LS elsewhere on the body. […] A skin biopsy can be taken to confirm a suspected diagnosis of vulvar LS; however, this is not always required. A small piece of the affected skin will be removed and sent to a pathologist to be examined with a microscope. […] An examination or tests may be done to exclude other conditions that could cause symptoms similar to those of vulvar LS, such as:

• #1 Lichen Sclerosus: Causes, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/skin-problems-and-treatments/lichen-sclerosis

  Lichen Sclerosus Diagnosis Your doctor can usually tell whether you have lichen sclerosus by doing a physical exam and checking on how your skin looks. […] They might order a biopsy, too if they think you could have skin cancer, or if treatments aren’t working. That means they’ll remove a small piece of your skin and send it to a lab to be viewed under a microscope.

• #1

• #1 Lichen sclerosus – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lichen-sclerosus/symptoms-causes/syc-20374448

  See your health care provider if you have symptoms of lichen sclerosus. […] If you’ve already been diagnosed with lichen sclerosus, see your health care provider every 6 to 12 months. These visits are important to check for any skin changes or side effects of treatment.

• #1 Comorbidity in patients with Lichen sclerosus: a retrospective cohort study | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-023-01335-9

  Lichen sclerosus (LS) is a chronic lymphocyte mediated inflammatory mucocutaneous disease of unknown aetiology with a predilection for the anogenital region, and affecting both sexes. […] The association between genital LS and different malignant tumours is a concern that needs to be further investigated. […] The present study revealed novel important data regarding the association of LS with cancer and autoimmune diseases, emphasising the importance of sufficient treatment and follow-up of patients with LS. […] Todays knowledge about LS is limited among medical professionals, sometimes resulting in wrong or delayed diagnosis, and inadequate treatment and follow-up. […] The primary aim of this study is to investigate whether the selected diagnoses are overrepresented in patients with LS compared to controls without LS.

• #2

  https://link.springer.com/article/10.1007/s40257-012-0006-4

  Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. […] Therefore, early diagnosis, prompt treatment, and long-term follow-up of affected patients are mandatory. […] Since LS begins with uncharacteristic symptoms, a meticulous clinical examination, raising the clinical suspicion and, if necessary, a histopathologic confirmation is required. […] The diagnosis of LS is usually clinical. When the clinical features are typical, histologic examination is not always essential. However, in the early stages of the disease the diagnosis can be difficult. […] In clinically inconclusive cases, a histologic examination is advisable and might close the gap, but should never be interpreted in isolation. […] A nonspecific biopsy does not rule out LS, but classic histologic findings confirm the diagnosis.

• #2 Lichen sclerosus: Causes, Diagnosis, and Images – DermNet

  https://dermnetnz.org/topics/lichen-sclerosus

  How is lichen sclerosus diagnosed? An experienced clinician can often diagnose lichen sclerosus by its appearance. Dermoscopy can provide further clues. Skin biopsy is frequently recommended. […] Histopathology may confirm the suspected diagnosis of lichen sclerosus. […] A focal area may undergo a biopsy to assess for cancer or SIL.

• #2 Lichen Sclerosus > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/lichen-sclerosus

  Lichen sclerosus may go undiagnosed for years because women are often too embarrassed to tell their doctor about their symptoms, says Amanda Zubek, MD, a Yale Medicine dermatologist. […] Doctors can often diagnose lichen sclerosus through a physical examination and a review of the patients medical history. In some cases, a doctor may perform a skin biopsy to aid in diagnosis. […] Lichen sclerosus is a life-long condition for which there is no cure. If the disease progresses or is left untreated, it may cause serious, debilitating symptoms. […] „A long-term maintenance treatment regimen is very important, and not just to prevent or treat symptom recurrence. Treatment to maintain normal skin color and texture reduces scarring and may prevent progression to skin cancer,” says Yale Medicine dermatologist Alicia Little, MD, PhD. […] At Yale Medicine, we take a proactive approach in treating lichen sclerosus. We start with potent topical steroids and educate the patient on the importance of continued treatment. Even if they dont have symptoms, preventing severe scarring or cancer is a priority, Dr. Zubek says.

• #2 Early diagnosis of lichen sclerosus et atrophicus often proves difficult

  https://www.dermatologytimes.com/view/early-diagnosis-lichen-sclerosus-et-atrophicus-often-proves-difficult

  Recognizable, but not always easily diagnosed, is lichen sclerosus et atrophicus. […] Carolyn A. Bangert, M.D., assistant professor, University of Texas at Houston, says although LS can be diagnosed visually, the condition usually comes to a physicians attention through other means. […] The problem is that when LS is not advanced enough for the visual diagnosis to be clear-cut, a biopsy tends to parallel the examination in that when skin changes are subtle, so are the biopsy results, Dr. Bangert says. […] Obviously, you dont want the LS get to that point, she says. You want to make a diagnosis before it progresses to the point where there are very obvious external changes on the vulva. […] Other conditions can look like LS, which can contribute to difficulty in diagnosing LS, Dr. Banger says.

• #2 Patient education: Vulvar lichen sclerosus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/vulvar-lichen-sclerosus-beyond-the-basics/print

  Lichen sclerosus (LS) is a skin disorder that causes the skin to become thin, whitened, and wrinkled and can cause itching or pain. […] Providers typically use the following methods to diagnose vulvar lichen sclerosus (LS). […] A medical history and physical examination of the vulvar and anal areas will be done, looking for the signs and symptoms of vulvar LS. A general skin examination may also be performed to exclude LS elsewhere on the body. […] A skin biopsy can be taken to confirm a suspected diagnosis of vulvar LS; however, this is not always required. A small piece of the affected skin will be removed and sent to a pathologist to be examined with a microscope. […] An examination or tests may be done to exclude other conditions that could cause symptoms similar to those of vulvar LS, such as:

• #2 Lichen Sclerosus Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1123316-workup

  Diagnosis of lichen sclerosus (LS) may often be made on the basis of clinical appearance, and ancillary examinations such as dermoscopy may help confirm the diagnosis. […] Biopsy should be performed in questionable cases, and in the course of follow-up, biopsy specimens from nonhealing ulcerations or masses should be examined to exclude malignant transformation. […] Skin biopsy (punch preferred) is the primary study for confirming the diagnosis of LS. A punch biopsy in the most mature area of the lesion is usually diagnostic. […] With ulcerative or vegetative genital lesions, biopsy may have to be done more than once to screen for squamous cell carcinoma (SCC). […] Epidermal hyperplasia or dysplasia associated with LS on vulvar biopsy specimens is associated with an increased risk of malignant transformation.

• #2 Vulval lichen sclerosus – diagnosis and treatment | Medicine Today

  https://medicinetoday.com.au/mt/2019/january/feature-article/vulval-lichen-sclerosus-%E2%80%93-diagnosis-and-treatment

  Vulval lichen sclerosus (VLS) is an important condition to diagnose correctly and manage actively for two reasons. First, if not treated aggressively it may significantly scar, shrink and deform the vulva and cause stenosis of the introitus with a resultant impact on quality of life. Second, it is a risk factor for malignant squamous cell neoplasia of the vulva with a lifetime risk in untreated or inadequately treated disease of 2 to 6%. […] The definitive diagnostic test for LS is a skin biopsy, which should be taken from the most densely white area. The histopathological characteristics are distinctive and uniform across all ages. […] Although VLS has a characteristic clinical appearance, a skin biopsy taken from the affected site at first presentation provides diagnostic confirmation and exclusion of alternative diagnoses. A positive biopsy result is also helpful in counselling the patient about the important long-term consequences and the need for follow up, and useful if the patient changes location or medical practitioner. […] In children, a clinical diagnosis is almost always sufficient because biopsy is traumatic, the list of possible differential diagnoses is small and neoplastic transformation has never been reported to occur in children with VLS.

• #2 Lichen Sclerosus | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/24256

  Lichen sclerosus (LS) is a chronic inflammatory disease. The diagnosis is based on the clinical features, but it is often confirmed by biopsy. […] The diagnosis is based on taking a careful history including the autoimmune diseases in the patient and family, examination of the mucosas, extragenital skin and completed by a gynecological exam. Thus, the diagnosis of LS is usually clinical. But in some cases, a biopsy can be performed. However, atypical histology does not rule out the diagnosis. […] Biopsies should be performed in case of atypical clinical presentation, suspected malignancy, or nonresponse, after an appropriate duration, to recommended first-line treatment.

• #2 Clinical Profile of Vulvar Lichen Sclerosuslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na52513/2020/11/13/clinical-profile-vulvar-lichen-sclerosus

  Vulvar LS can be mistaken for several other vulvar disorders. Lichen planus may have similar vulvar features but also tends to involve the vagina. LSC also causes vulvar itching and scratching, often arising from chronic irritation without architectural changes. Histologic features of LSC include acanthosis, hyperkeratosis, and inflammatory infiltrates. Genitourinary syndrome of menopause, candidiasis, and vitiligo are also included in the differential diagnosis. To narrow the diagnosis, we recommend yeast culture and possibly wet mount as part of the initial evaluation.

• #2 Lichen sclerosus | The Royal Women’s Hospital

  https://www.thewomens.org.au/health-information/vulva-vagina/vulva-vagina-problems/lichen-sclerosus

  Lichen sclerosus (said ‘like-en skler-oh-sus’) is a skin condition that makes patches of skin look white, thickened and crinkly. It most often affects the skin around the vulva or anus. […] Your doctor can diagnose lichen sclerosus by looking at your vulva. Sometimes they might take a small sample of your vulvar skin (called a biopsy) and send it away to a laboratory for testing. […] Unfortunately, lichen sclerosus is sometimes mistaken for thrush, which also causes vulvar itchiness. If your symptoms persist, you should see a skin specialist (a dermatologist) or women’s health specialist (a gynaecologist). […] Lichen sclerosus is often mistaken for thrush so see your doctor if you are often itchy in the vulvar or anal area.

• #2 Lichen sclerosus: Symptoms, Causes, and Treatment

  https://patient.info/womens-health/vulval-problems-leaflet/lichen-sclerosus

  Lichen sclerosus is an uncommon skin condition. […] How is lichen sclerosus diagnosed? […] The appearance is often fairly typical, in which case no further tests are needed. If the diagnosis is in doubt, a small sample (biopsy) of affected skin may be taken under local anaesthetic. […] The sample of skin is put under a microscope to look at the structure of the skin cells and tissues. This can confirm the diagnosis and rule out other disorders which can sometimes copy (mimic) this condition. […] If lichen sclerosus is diagnosed it is usual also to do a routine blood test to check for an underactive thyroid gland. This is because of the association between lichen sclerosus and autoimmune diseases and, in particular, autoimmune thyroid disease. Up to 3 in 10 people with lichen sclerosus also have an underactive thyroid gland.

• #2 Lichen sclerosus – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000340

  Lichen sclerosus (LS, also known as balanitis xerotica obliterans in men) is an inflammatory skin condition with a chronic relapsing and remitting course. […] Diagnosis is predominantly clinical, but confirmation by biopsy is recommended if there is diagnostic uncertainty or suspicion of malignancy. […] 1st investigations to order: clinical diagnosis. […] Investigations to consider: skin biopsy. […] Emerging tests: optical coherence tomography (OCT), high-frequency ultrasound.

• #2

  https://ugeskriftet.dk/dmj/childhood-lichen-sclerosus-rare-important-diagnosis

  The clinical history and appearance of the lesions are usually very characteristic. A biopsy is rarely needed in children, unless atypical or neoplastic changes are suspected or if the disease fails to respond to adequate therapy. […] In conclusion, anogenital LS in children is a rare diagnosis mostly seen in girls. To avoid diagnostic delay, symptoms of anogenital pruritus, bleeding, dysuria and obstipation should lead to an examination of the anogenital skin and LS should be considered, also in prepubertal children. If children have persistent anogenital complaints or skin changes despite medical treatment, they should be referred to a dermatologist. Delay in diagnosis and treatment can lead to severe scarring of the anogenital area. Potent corticosteroids are very effective in treatment of this disease.

• #2 Lichen Sclerosus: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16564-lichen-sclerosus

  Lichen sclerosus is a chronic inflammatory condition that affects skin on your genitals. […] Healthcare providers will diagnose lichen sclerosus. Theyll ask questions about your symptoms and perform a physical examination, which includes an evaluation of your affected areas. […] To confirm their lichen sclerosus diagnosis, your healthcare provider may perform a biopsy. […] Yes, healthcare providers can treat lichen sclerosus without circumcision. Circumcision can sometimes treat lichen sclerosus, but there are other options. […] An essential part of lichen sclerosus treatment includes regular checkups with a healthcare provider. Theyll watch for signs of skin cancer and help prevent scarring around your genitals. […] The sooner a healthcare provider can diagnose lichen sclerosus and provide treatment, the better the outlook. However, even with early diagnosis and treatment, symptoms may appear randomly for the rest of your life.

• #2 Patient education: Vulvar lichen sclerosus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/vulvar-lichen-sclerosus-beyond-the-basics

  Lichen sclerosus (LS) is a skin disorder that causes the skin to become thin, whitened, and wrinkled and can cause itching or pain. […] Providers typically use the following methods to diagnose vulvar lichen sclerosus (LS). […] A medical history and physical examination of the vulvar and anal areas will be done, looking for the signs and symptoms of vulvar LS. […] A skin biopsy can be taken to confirm a suspected diagnosis of vulvar LS; however, this is not always required. […] An examination or tests may be done to exclude other conditions that could cause symptoms similar to those of vulvar LS, such as: […] Diagnosing vulvar LS early, treating it effectively, and biopsying any abnormal areas may help to reduce the risk of developing or missing a diagnosis of skin cancer. […] A once-yearly examination of the skin of the vulva is recommended, and women should examine themselves regularly (for example, monthly) for lumps or sores that do not heal. […] A biopsy should be performed if there are areas that do not improve with treatment.

• #2 Comorbidity in patients with Lichen sclerosus: a retrospective cohort study | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-023-01335-9

  The secondary aim is to spread awareness about LS and its potential risk of developing into cancer, and to encourage further studies of LS to understand its etiology, pathophysiology and malignant potential. […] The results indicated that patients with LS had an increased risk of several of the malignant diagnoses and premalignant lesions studied, including vulvar cancer (OR=17.4; 95% CI 12.125.3), penis cancer (OR=9.1; 95% CI 4.318.9), prostate cancer (OR=2.0; 95% CI 1.62.4), breast cancer (OR=1.6; 95% CI 1.41.8). […] The current study did not find a significant association between LS and malignant tumors of the testicle or urethra, nor for thyroiditis, myasthenia gravis, multiple sclerosis or GuillainBarr syndrome. […] The outcomes of this study not only validate the well-established risk of vulvar and penile cancer development but also uncover novel insights concerning LS. […] These newfound revelations affirm the clinical suspicions of a positive correlation between LS and malignant tumors of the prostate, breast, and other diseases.

• #2 Lichen Sclerosus | Doctor

  https://patient.info/doctor/lichen-sclerosus-pro

  Specialist advice on treatment may be needed – eg, if a woman does not appear to respond to treatment. Men with urinary symptoms should be referred to a urologist. Vulval clinics and urology clinics have a role, particularly if there are complications. […] Long-term follow-up is needed for women with LS, particularly for patients on long-term steroids and with poorly controlled LS. […] Patients who respond well to treatment and need only small amounts of topical steroids should be reviewed annually – this can be in primary care. Give patients clear instructions to report immediately any persistent new lumps, skin changes, erosions or ulcers. […] […] […] The current evidence demonstrates the efficacy of clobetasol propionate, mometasone furoate, and pimecrolimus in treating genital lichen sclerosus.6 Clobetasol has been demonstrated to be more effective than pimecrolimus.78

• #2 Lichen Sclerosus—Incidence and Comorbidity: A Nationwide Swedish Register Study

  https://www.mdpi.com/2077-0383/13/10/2761

  Lichen sclerosus (LS) represents a chronic, lymphocyte-mediated inflammatory condition that primarily affects mucocutaneous regions, with a notable predilection for anogenital sites. […] The primary therapeutic approach involves the application of potent topical steroids (clobetasol ointment) to the affected regions. In male patients, circumcision may serve as a curative treatment option when topical steroids fail. […] Delayed diagnosis or steroid resistance may compel the need for genital reconstruction to restore functionality. […] Moreover, neglected LS in the vulvar area can evolve into a premalignant state or progress to vulvar squamous cell carcinoma (SCC), while penile LS poses a risk for penile SCC. […] Current awareness of LS among medical professionals is inadequate, often leading to misdiagnosis, delayed treatment, and insufficient follow-up.

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