Lichen sclerosus

Summary

Lichen sclerosus (LS – chronic dermatosis with an autoimmune pathogenetic background) is one of the frequent diseases of the vulva. The classification of vulvar dermatoses, of which LS is one, was renewed in the year 2006 – ISSVD Classification of vulvar dermatoses. The underlying pathogenetic mechanism is considered to be a disorder of autoimmune mechanisms. Genetic predisposition may play a role as well. The most common manifestation of LS is pruritus, pain, changes of the epidermis and mucosa. In differential diagnosis vitiligo, lichen simplex chronicus and lichen planus should be considered. Diagnostic biopsy and histological verification of the lesion must be made when symptoms do not disappear soon after treatment is initiated or when bleeding or ulceration is present within the lesion. The treatment of LS has changed in recent years. The first choice therapy is the topic application of very strong (ultrapotent) steroids such as clobetasol propionate, and the use of antimycotic treatment is often needed. Surgical therapy (vulvectomy) has been abandoned. Because of the complexity of this disease, cooperation between both the dermatologist and the gynaecologist is needed.

Key words:
vulvar dermatose, lichen sclerosus, ISSVD (International Society for the Study of Vulvovaginal Disease) classification, immunity disorder, ultrapotent steroids.