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lichen_sclerosus

Lichen sclerosus

Related Terms: Lymphedema, Leg Lymphedema, Arm Lymphedema, Lichen sclerosus, skin, skin care, inflammation, inflammatory response, subcutaneous tissues

Discussion

Due to our immunocompromised lymphedematous limb, we seem to be terribly susceptible to an unending list of skin growths, rashes and complications. The limb swelling contributes to the problem by creating folds in the skin that are hard to keep clean, dry and sanitized.

Lichen sclerosus is a long-term problem of the skin. It usually targets the genital and anal areas. Sometimes, however, lichen sclerosus appears on the upper body, breasts and upper arms.

Women, after menopause are more likely to come down with it then men are and it is rare in children.

Symptoms

White shiny, and smooth spots appear early on the skin. Later, the spots grow into larger patches. The skin on the patches becomes thin and crinkled. Then the skin tears easily, and bright red or purple bruises are common. Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms.

Other symptoms are:

•Itching (very common)

•Discomfort or pain

•Bleeding

•Blisters

•In severe cases, bleeding, blistering or ulcerated lesions

•Painful intercourse

•Tenderness of the affected areas of your skin

•Easy bruising or tearing

Causes

The actual cause is not known at the present time. Ironically, many doctors think a too active immune system (an autoimmune problem) and/or hormone problems may play key roles.

Infections may play a role as well. This include both bacterial and viral pathogens.

It is also believed that people may inherit the susceptibility of getting the disease. Finally, lichen sclerosus appears on skin that has been damaged or scarred from some type of injury/trauma. (1)

Because our LE limbs are actually immunocompromised, I personally wonder what role inflammation may play in getting the condition. Lymphedema is in and of itself an inflammatory process.

The condition also is NOT contagious and/or transferable to another individual.

Diagnosis

Diagnosis can be achieved through a physical examination of the affected area. Most doctors however, will take a small skin biopsy to confirm the correct diagnosis.

Complications

Malignancy

Persistent lichen sclerosus in one location may slightly increase your risk of skin cancer, although this has not yet been definitively proved. For this reason, make sure that you have follow-up examinations every six to 12 months. Squamous cell carcinoma (SCC) has been described predominantly in association with female genital LS and less commonly in penile LS. It is not associated with extragenital LS. Less commonly the malignancy is a verrucous carcinoma. Melanoma, basal cell carcinoma and Merkel cell carcinoma have all been reported rarely in patients with vulval LS but no studies suggest that there is an increased frequency of these tumours. There appear to be two pathogenetic mechanisms for vulval SCC: firstly, SCC in younger women is associated with the oncogenic human papillomavirus (HPV); and secondly, in older women, the association is with a chronic scarring dermatosis such as. (3)

Other potential complications:

In women, the uncomfortable itching and scarring that accompanies severe lichen sclerosus may narrow the vaginal opening and affect the ability or desire to have sexual intercourse. In some cases, the blistering may create extremely sensitive skin to the point that any pressure on the area is unbearable. In men, lichen sclerosus can in rare cases involve the foreskin. The tightening and thinning of the foreskin may create complications during erections or when urinating. (3)

Treatment

Treatment is generally not necessary as the skin patches go away over time on the arms and/or legs.

Lichen sclerosus of the genital skin should be treated. Even if it isn't painful or itchy, the patches can scar. This can cause problems with urination or sex. There is also a very small chance that skin cancer may develop in the patches.

Surgery is normally a good option for men. Circumcision (removing the foreskin on the penis) is the most widely used therapy for men with lichen sclerosus. The disease usually does not come back. Surgery is normally not a good option for women. When the lichen sclerosus patches are removed from the genitals of women and girls, they usually come back. Treatment also includes using very strong cortisone cream or ointment on the skin. You put these creams on the patches every day for several weeks. This stops the itching. Then you use the cream or ointment two times a week for a long time to keep the disease from coming back. Treatment does not fix the scarring that may have already occurred. (1) In men, surgical debridement or removal is usually performed if the condition appears on the foreskin,. Surgery is not recommended for women because the condition may come back after surgery.

Prognosis

The prognosis for lichen sclerosus is excellent, although since the risk of skin cancer increases with lichen sclerosus, regular follow up is necessary with a dermatologist.

(1) NIH Health Info

(2) Medscape

(3) Mayo Clinic

Abstracts and Studies

Lichen Sclerosus: A 5-Year Follow-Up After Topical, Subdermal, or Combined Therapy.

Jan 2012

Ventolini G, Swenson KM, Galloway ML.

Source

Boonshoft School of Medicine, Wright State University, Dayton, OH.

Abstract

Keywords: lichen sclerosus, topical, subdermal, therapy

OBJECTIVE: The purpose of our study was to compare clinical data regarding patients with pruritic lichen sclerosus (LS) at moderate or severe stages using 2 different therapies with a 5-year follow-up.

MATERIALS AND METHODS: The study was approved by the institutional review board and was presented as a retrospective clinical data review of patients with pruritic biopsy diagnosis LS who underwent therapy at our university private practice from 2002 to 2005. We compared the results of a weekly topical application of high-potency steroid (HPS) with a combined HPS and monthly anesthetic/steroid subdermal injection (ASI). Outcomes were timed to achieve pruritus-free status, the number of symptomatic recurrences, and patient satisfaction with therapy.

RESULTS: Fifty-four patients were diagnosed with LS between 2002 and 2005. There were 13 patients who had mild-stage, 25 who had moderate-stage, and 16 who had severe-stage LS. Five-year follow-up data on 17 patients with moderate-stage LS and 14 patients with severe-stage LS were obtained. Time to pruritus free was 6 weeks with ASI and 19 weeks with HPS for moderate-stage LS (p = .04) and 9 weeks with ASI and 24 weeks with HPS for severe-stage LS (p = .03). Recurrences were more frequent on HPSfor moderate-stage LS (p = .04) but not significant with HPS for severe-stage LS (p = .15). Only ASI was successful at treating patients with recalcitrant pruritus.

CONCLUSIONS: In our population, patients with symptomatic moderate-stage LS seem to have a more rapid and prolonged response to ASI than to HPS but are less satisfied with the injections.

Lower Genital Tract Disease

The co-existence of vulvar lichen sclerosus, ulcerated calcinosis cutis, and dermatomyositis: coincidence or immunological mechanism?

Dec 2011

Balcı DD, Celik E, Sarıkaya G, Yenin JZ, Atik E.

Source

Department of Dermatology, Faculty of Medicine, Mustafa Kemal University, Antakya-Hatay, Turkey.

Abstract

Calcinosis cutis is a condition characterized by the deposition of calcium salts in the skin and subcutaneous tissues, and patients suffering from it encounter various connective tissue disorders, such as dermatomyositis (DM), scleroderma, and systemic lupus erythematosus. Although calcinosis cutis is frequently accompanied by juvenile dermatomyositis, rare cases have been reported in adult patients with DM. On the other hand, lichen sclerosus (LS) is a chronic inflammatory disease of the skin and mucosal surfaces. In the present report, we present a rare case of a 71-year-old patient with DM accompanied by ulcerated calcinosis cutis and vulvar LS.

Annals of Dermatology

A case of lichen sclerosus et atrophicus accompanying bullous morphea.

Dec 2011

Yasar S, Mumcuoglu CT, Serdar ZA, Gunes P.

Source

Department of Dermatology, Haydarpaş Numune Training and Research Hospital, Istansbul, Turkey.

Abstract

Keywords: Lichen sclerosus et atroficus, Scleroderma, localised

Bullous morphea is a rare form of morphea characterized with bullae on or around atrophic morphea plaques. Whereaslichen sclerosus et atrophicus (LSA) is a disease the etiology of which is not fully known, and which is characterized with sclerosis. Coexistence of morphea and LSA has been identified in some cases. Some authors believe that these two diseases are different manifestations which are on the same spectrum. The 70-year-old patient stated herein, presented to us for 6 months with annular, atrophic plaques, ivory color in the middle, surrounded by living erythema, on the front and back of the trunk. Occasionally bulla formation on the plaques on the trunk lateral was identified. Fibrotic and atrophic plaques of ligneous hardness were present on the front side of tibia of both legs. In the histopathologic examination, the lesions were found concordant with bullous morphea and LSA. With colchicine 1.5 mg/day, pentoxifylline 1,200 mg/day, topical calcipotriol ointment and clobetasol propionate cream, the erythema in the patient's lesions faded and softening in the fibrotic plaques was observed. Concomitance of bullous morphea and LSA is a rarely seen, interesting coexistence which suggests a common, as yet unknown, underlying pathogenesis.

Annals of Dermatology

Metalloproteinases 2 and 9 and their tissue inhibitors 1 and 2 are increased in vulvar lichen sclerosus.

Dec 2011

de Oliveira GA, de Almeida MP, Soares FA, de Almeida Filho GL, Takiya CM, Otazu IB, Nasciutti LE.

Source

Programa de Biologia Estrutural, Instituto de Bioquímica Médica, Centro Nacional de Ressonância Magnética Nuclear Jiri Jonas, Universidade Federal do Rio de Janeiro, 21941-590 Rio de Janeiro, RJ, Brazil.

Abstract

Keywords: Vulvar lichen sclerosus; Metalloproteinases (MMPs); Tissue inhibitors of metalloproteinases (TIMPs); Extracellular matrix

OBJECTIVES: To evaluate the expression of different matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in vulvar lichen sclerosus (LS), a chronic dermatosis in women, histologically characterized by a zone of collagen remodeling in the superior dermis.

STUDY DESIGN: Analysis of the expression of different MMPs (MMP-1, -2, -9 and -13) and TIMPs (TIMP-1 and -2) by reverse transcriptase-polymerase chain reaction (RT-PCR) in vulvar biopsies from patients with LS (n=11), classified according to Hewitt histological criteria and compared with clinically normal vulvar tissue (n=5), and the immunohistochemistry of MMP-2 and -9 and TIMP-1 and -2 distribution in the remodeling zone of LS (n=31) and in clinically normal vulvar tissue (n=28).

RESULTS: Although no statistically significant difference between LS and normal skin groups at the mRNA level of MMP and TIMP transcripts was shown, an increase in the immunodistribution of MMP-2 and -9 and TIMP-1 and -2 in LS compared to normal vulvar skin was observed.

CONCLUSIONS: These results suggest that these molecules could be related to the process of cutaneous collagen remodeling in LS pathology.

SciVerse

External Links

Lichen sclerosus exhibiting histologic signs of lymphedema: an essential factor in the pathogenesis of verruciform xanthoma.

Feb 2012

Carlson JA, Carlson GD, Murphy M, Rohwedder A.

Source

Albany Medical College, 47 New Scotland Ave, MC-81, Albany, NY 12208. CarlsoA@mail.amc.edu

PubMed

Re: Histological Evidence of Urethral Involvement in Male Patients With Genital Lichen Sclerosus: A Preliminary Report: G. Barbagli, F. Mirri, M. Gallucci, S. Sansalone, G. Romano and M. LazzeriJ Urol 2011; 185: 2171-2176.

Differential expression of connective tissue growth factor and extracellular matrix proteins inlichen sclerosus.

Classifications and Descriptions

ICD-10 L90.0

ICD-9 701.0

eMedicine derm/234

MeSH D018459

Diagnostic Images

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lichen_sclerosus.txt · Last modified: 2012/10/16 14:40 (external edit)