Lichen sclerosus et atrophicus: diagnosis and treatment

Aurora Parodi, MD
DISSAL University of Genoa/IRCCS AOU San Martino-IST Genoa, Italy

Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. It causes itch, pain, dysuria, dyspauremia and other abnormalities. About 6% of LS are isolated extragenital lesions.
The diagnosis is usually clinical and when the clinical features are typical, histologic examination is not essential.
To treat lichen sclerosus, emollients are useful as to minimize irritants.
Ultrapotent or potent topical corticosteroids or other immunosuppressants as topical calcineurin inhibitors have a significant anti-inflammatory activity.
Topical testosterone has been abandoned because of ineffectiveness and side effects in particular in women. Surgery should be limited to patients with associated malignancy or to patients who need correction of scarring processes.
Other therapy as phototherapy and photodynamic therapy have to be better studied.
A long term follow up, in particular for genital lesions, is mandatory.

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