Lichen Planus – Lichen Sclerosus

Lichen Sclerosus, also called Lichen Sclerosus et Atrophicus, is a skin condition that can occur at any age and equally amongst the sexes and I encounter this skin disease in both my The Woodlands dermatology and Conroe dermatology offices.  Clinically, Lichen Sclerosus begins as white lichenoid flat topped polygonal papules, atrophic patches and plaques.  Follicular comedonal openings are usually seen within the lesions.  A rim of erythema (redness) usually encompasses an atrophic central area which may appear smooth and wrinkled.  Most patients with Lichen Sclerosus experience intense pruritus.  The vulva/vagina is frequently affected in women and the normal anatomic structures may ultimately be obliterated and not recognizable.  The penis can be involved in men leading to a condition called Balanitis Xerotica Obliterans in which phimosis occurs (the foreskin becomes attached to the glans and unretractable).  In many patients, circumcision can cause Balanitis Xerotica Obliterans to resolve.  Patients with Lichen Sclerosus are at an increased risk of developing Squamous Cell Cancer in the lesions.  Treatment of Lichen Sclerosus is with ultrapotent topical steroids, which may seem unusual as the lesions are atrophic.