- Lichen sclerosus: causes
- Lichen sclerosus: symptoms
- Lichen sclerosus: diagnosis and differentiation
- lichen sclerosus: treatment
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Lichen sclerosus is a disease of unknown etiology, characterized by chronic inflammation of the skin in the form of porcelain-white papular lesions and periventicular keratosis. What are the other symptoms of lichen sclerosus? How is his treatment going?
Lichen sclerosus( lichen sclerosus ) is manifested by the appearance of porcelain-white lesions of a papular nature, merging into larger, slightly hardened lesions, which may be accompanied by variously intense follicular hyperkeratosis - excessive keratosis of the hair follicles. Lichen sclerosus affects both sexes, but it is more common in women with two peaks - before puberty and between the 5th and 6th decade of life. The disease can also affect children.
Lichen sclerosus: causes
It is assumed that autoimmune factors and certain genetic predispositions play a role in the development of this disease. About 75% of women with lichen sclerosus have antibodies to extracellular matrix protein 1 (ECM-1), indicating that the protein is one of the likely autoantigens. Interestingly, some women experience spontaneous remissions during puberty, which may suggest the possible involvement of hormonal factors in the development of this skin disease.
Lichen sclerosus: symptoms
The first lesion that disturbs the patient is a single spot or multiple scattered spots of smaller diameter. These lesions can be located on the side of the neck, the collarbones, arms, the area between and below the breasts, and on the flexion surfaces of the hands.
Changes in the oral mucosa - especially the cheeks and under the tongue - are very rare. They then take the form of white plaques.
In the early stage of the disease, porcelain-white, slightly raised plaques, less than 1 cm in diameter, are observed, which may gradually enlarge and merge into larger, irregularly shaped lumps.
Older lesions are atrophic, have a parchment-like surface and coexist with comedone-like foci of follicular keratosis. It is also possible for the epidermis to separate fromdermis with the formation of a bladder.
In the case of lichen sclerosus within the external genitalia, the vulva, perineum and perianal area are most often affected in women, and the glans and foreskin in men. These areas can become scarred, distorted and may form bleeding blisters, leading to dyspareunia (pain during intercourse). In men, glans inflammation and phimosis may also develop, and in women, cirrhosis of the vulva. The occurrence of nagging itching is also characteristic. It is worth remembering that outbreaks of lichen sclerosus in the genital area may constitute potential precancerous lesions.
Lichen sclerosus: diagnosis and differentiation
The diagnosis of lichen sclerosus is based on a thorough dermatological examination and the identification of characteristic skin changes. In doubtful cases, a sample is taken for histopathological examination.
Differentiation includes diseases such as localized scleroderma ( morphea ), focal form of lupus erythematosus (DLE), atrophic lichen planus, psoriasis, Bowen's disease and vitiligo.
lichen sclerosus: treatment
Topical treatment is usually effective with the topical application of 0.05% clobetasol propionate twice daily for up to 4 weeks. In refractory cases, intralesional injections of corticosteroids (triamcinolone acetonide solution with a local anesthetic) are used. This is especially true in the presence of intensely itchy or chronic lesions on the external genitalia. However, it should be borne in mind that the use of glucocorticosteroids may lead to atrophic changes in the skin. Lubricants are a good thing if you feel dry. Patients should also exercise good hygiene and avoid irritants, as well as frequent baths with hard soaps. In addition, calcineurin inhibitors and UVA1 or PUVA-bath therapy are used in local therapy.
Oral retinoids such as Acitretina and Isotretinoin are used in general treatment, but their use requires close monitoring (especially in women) and further research.