Case history
Case history #1
A 68-year-old woman presents with pruritus and pain with urination. Despite using non-prescription antipruritic creams, her symptoms have not improved. She has not been sexually active for 3 years due to pain on penetration; she is not using vaginal oestrogen therapy. Examination reveals depigmented lichenified plaques with overlying erosions, agglutination of the labia minora, and complete fusion of the clitoral hood.
Case history #2
A 29-year-old man presents with a 3-year history of itching and burning of the penis. He mentions that his foreskin is very tight and reports discomfort and occasional tearing of the foreskin during sexual intercourse. On examination, he has symmetrical, white, atrophic patches on the glans penis, meatal stenosis, and a tight, inflamed foreskin.
Other presentations
Lichen sclerosus (LS) can also occur in prepubertal children, and with extragenital presentations in both children and adults.
When anogenital LS occurs in prepubertal girls, it may present with similar features as in women, such as pruritus and skin changes; however, there may more commonly be issues with constipation, soiling, anal fissures, and associated bleeding.[7] Boys are commonly asymptomatic but often present with phimosis.[10]
Patients may present with extragenital skin lesions, but this is a rare manifestation of lichen sclerosus. Extragenital skin lesions are often asymptomatic but may be associated with pruritus. If a patient presents with extragenital disease, ask about anogenital symptoms as a part of the history and perform an examination of the genitalia in addition to a general skin examination. Lichen sclerosus may also appear in areas of skin subjected to trauma (for example, in obstetric scars/due to rubbing from tight clothing or bicycle saddles).[11] The precipitation of disease activity in areas of trauma is known as the Koebner phenomenon.
Use of this content is subject to our disclaimer