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Oral lichen sclerosus — Clinical Guidelines

Overview

Lichen sclerosus (LS) is an inflammatory skin disease affecting individuals of all ages, predominantly involving the anogenital region, causing symptoms such as itching, soreness, and potential complications like scarring, sexual dysfunction, and increased cancer risk 1 2 5.

Diagnosis

Clinical Presentation: Whitening of genital skin, often preceded by redness and edema; may progress to fissuring, scarring, and structural changes 1 2.

Histopathology: Characteristic features include homogenization of the reticular dermis, loss of elastic fibers, and a thinned epidermis 5.

Differential Diagnosis: Includes other inflammatory dermatoses and conditions affecting the genital area 5.

Management

First-Line Treatment: Topical corticosteroids (e.g., mometasone furoate 0.1% ointment for 12 weeks) 4 7.

Adjunctive Therapies:

- Immunosuppressants: May be considered for refractory cases (e.g., topical tacrolimus) 5. - Photodynamic Therapy: For refractory cases, often requiring conscious sedation (e.g., inhaled nitrous oxide/oxygen premix) 11.

Follow-Up: Regular monitoring to assess clearance and prevent complications 3 5.

Special Populations

Pediatrics: Requires close follow-up due to risk of scarring; management strategies include pediatric dermatologists and gynecologists 3.

Elderly: Management similar to adults but may require consideration of comorbidities and treatment adherence 11.

Comorbidities: No specific guidelines noted, but management should consider overall health status 5.

Key Recommendations

Initiate Treatment with Topical Corticosteroids: For symptomatic and asymptomatic cases to prevent progression and complications (Evidence: Moderate) 4 7.

Regular Monitoring Essential: To assess treatment efficacy and manage potential complications such as scarring and cancer risk (Evidence: Expert opinion) 3 5.

Consider Adjunctive Therapies for Refractory Cases: Including immunosuppressants or photodynamic therapy under appropriate sedation (Evidence: Weak) 11 5.

References

1 Kirtschig G, Kinberger M, Kreuter A, Simpson R, Günthert A, van Hees C et al.. EuroGuiderm guideline on lichen sclerosus-Treatment of lichen sclerosus. Journal of the European Academy of Dermatology and Venereology : JEADV 2024. link 2 Kirtschig G, Kinberger M, Kreuter A, Simpson R, Günthert A, van Hees C et al.. EuroGuiderm guideline on lichen sclerosus-introduction into lichen sclerosus. Journal of the European Academy of Dermatology and Venereology : JEADV 2024. link 3 Pennesi CM, Khilnani A, Marathe KS, Dowlut-McElroy T, Habeshian K. Lichen Sclerosus: A Survey of Diagnosis and Management Among Pediatric Dermatologists and Gynecologists. Journal of drugs in dermatology : JDD 2024. link 4 Borghi A, Flacco ME, Zedde P, Toni G, Schettini N, Corazza M. Does Clearance of Vulvar Lichen Sclerosus after a Corticosteroid Treatment Correspond to a Decrease in Disease-Related Burden? Results from a Cohort Study Using Pictorial Representation of Illness and Self-Measure and the Dermatology Life Quality Index. Dermatology (Basel, Switzerland) 2023. link 5 Papini M, Russo A, Simonetti O, Borghi A, Corazza M, Piaserico S et al.. Diagnosis and management of cutaneous and anogenital lichen sclerosus: recommendations from the Italian Society of Dermatology (SIDeMaST). Italian journal of dermatology and venereology 2021. link 6 Kuraitis D, Stumpf B, Murina A. Discrepancies by dermatology resident gender in diagnostic confidence and management of female and male genital lichen sclerosus. Dermatology online journal 2020. link 7 Borghi A, Odorici G, Scuderi V, Valpiani G, Morotti C, Corazza M. Measuring perceived benefit and disease-related burden in patients affected with vulvar lichen sclerosus after a standard topical corticosteroid treatment. Results from a cohort study using Pictorial Representation of Illness and Self-measure and Dermatology Life Quality Index. Dermatologic therapy 2020. link 8 Doche I, Romiti R, Hordinsky MK, Valente NS. "Normal-appearing" scalp areas are also affected in lichen planopilaris and frontal fibrosing alopecia: An observational histopathologic study of 40 patients. Experimental dermatology 2020. link 9 Osterberg EC, Gaither TW, Awad MA, Alwaal A, Erickson BA, McAninch JW et al.. Current Practice Patterns Among Members of the American Urological Association for Male Genitourinary Lichen Sclerosus. Urology 2016. link 10 Selk A. A Survey of Experts Regarding the Treatment of Adult Vulvar Lichen Sclerosus. Journal of lower genital tract disease 2015. link 11 Cabete J, Campos S, Lestre S. Conscious sedation with inhaled 50% nitrous oxide/oxygen premix in photodynamic therapy sessions for vulvar lichen sclerosus treatment. Anais brasileiros de dermatologia 2015. link 12 Heymann WR. Lichen sclerosus. Journal of the American Academy of Dermatology 2007. link 13 Kavak A, Kutluay L. Nail involvement in lichen striatus. Pediatric dermatology 2002. link 14 Harahap M, Marwali MR. The treatment of lichen amyloidosis. A review and a new technique. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 1998. link 15 Tidy JA, Soutter WP, Luesley DM, MacLean AB, Buckley CH, Ridley CM. Management of lichen sclerosus and intraepithelial neoplasia of the vulva in the UK. Journal of the Royal Society of Medicine 1996. link 16 Dalziel K, Reynolds AJ, Holt PJ. Lichen sclerosus et atrophicus with ocular and maxillary complications. The British journal of dermatology 1987. link 17 Toda K, Okamoto H, Horio T. Lichen striatus. International journal of dermatology 1986. link 18 Abd El-Aal H, Salem SZ, Salem A. Lichen myxedematosus: histochemical study. Dermatologica 1981. link 19 Waisman M, Waisman M. Lichen aureus. Archives of dermatology 1976. link

Oral lichen sclerosus