Chronic inflammatory skin disease of the anogenital region

Aetiology

• Cause largely unknown - may be autoimmune, genetic, microincontinence, hormonal
• 6-10 times more common in females
• Can occur at any age, two peaks - prepubertal girls and post-menopausal women
• Association with other autoimmune conditions and smoking

Pathophysiology

• Upon microscopy, lichen sclerosus characteristically causes atrophy; producing a thin stratified squamous epithelium
• A band-like infiltrate of chronic inflammatory cells can be observed beneath this epithelial layer

Clinical features

Symptoms

• Itch, pain and dyspareunia
• Constipation (especially in children)
• Psychosexual impact

Signs

• White papules and plaques (vulval and perineal skin, figure of 8 pattern, ecchymosis, erosions, and fissures)
• Architectural change
• Extragenital skin involvement

Investigations