Management of Lichen Sclerosus and Associated Conditions
Summary
Lichen sclerosus is a chronic, lymphocyte-mediated inflammatory dermatosis of unknown aetiology, characterised by atrophic, porcelain-white patches predominantly affecting the anogenital region of postmenopausal women, with occurrences in men and children. Clinical manifestations include intense pruritus, pain, sexual and urinary dysfunction, and in advanced stages, scarring that can impair function. A small but significant risk of progression to squamous cell carcinoma necessitates vigilant surveillance. First-line management consists of long-term application of ultrapotent topical corticosteroids, often delivered in maintenance regimens to minimise relapse. Topical calcineurin inhibitors serve as steroid-sparing options or for refractory cases. Emerging adjunctive modalities under investigation include photodynamic therapy, photobiomodulation and regenerative approaches using adipose-derived cell fractions. Accurate diagnosis relies on clinical examination, supported by histopathology in ambiguous or treatment-resistant presentations. Optimal care is delivered through a multidisciplinary framework, incorporating patient education to foster adherence, self-management and quality of life. Holistic assessment extends to screening for associated autoimmune disorders and malignancies, alongside psychosocial support. Despite therapeutic advances, there remains no definitive cure, underscoring the need for ongoing translational research to elucidate pathogenesis and refine targeted treatments.
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Management of Lichen Sclerosus and Associated Conditions publication trend
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Technical terms
Lichen sclerosus: A chronic inflammatory skin disorder characterised by whitish, atrophic patches most often affecting the anogenital region.
Ultrapotent topical corticosteroid: A high-strength anti-inflammatory preparation applied to the skin to suppress immune-mediated inflammation.
Calcineurin inhibitor: A topical immunomodulatory agent that inhibits T-cell activation and reduces cutaneous inflammation.
Autoimmunity: A pathological immune response directed against the body’s own tissues.
Atrophic lesion: A thin, sclerotic skin area resulting from loss of epidermal and dermal structures due to chronic inflammation.
References
- Lichen sclerosus: The 2023 update. Frontiers in Medicine (2023).
- Comorbidity in patients with Lichen sclerosus: a retrospective cohort study. European Journal of Medical Research (2023).
- Living with vulval lichen sclerosus: a qualitative interview study*. British Journal of Dermatology (2022).
- Safety and Efficacy of Stromal Vascular Fraction Enriched Fat Grafting Therapy for Vulvar Lichen Sclerosus. Cureus (2020).
- Structured analysis of histopathological characteristics of vulvar lichen sclerosus in a juvenile population. Human Pathology (2020).
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