Lichen Sclerosus in Women
I read the article by Becker with great interest as it raises awareness for a widely unknown pathology.
Lichen sclerosus is still often regarded as a rare disease that affects mainly older women; the reason for this is that for a long time it was recognized only during the later stages. Now we suspect that up to 1% of women are affected, little girls and young women among them. Many patients have gone through many useless diagnostic tests and therapies (anti-infective drugs). My youngest patient was 3 years old.
In women and perhaps also in men, early diagnosis and treatment are crucial for the disease course since appropriate treatment helps to mostly avoid late sequelae such as uncontrollable pruritus, atrophy, synechiae, and degenerative changes. Histological analysis is not always required—a close look, preferably using a colposcope, and experience are usually sufficient. The symptoms of chronic pruritus, discrete white coloration, and skin injuries such as dermatorrhagia and rhagades subsequent to permanent scratching) and exclusion of fungal infections enable a clinical diagnosis more readily.
Treatment with corticosteroid ointment is standard treatment in women today and yields the best results during the early stages. However, fatty ointment without any water is equally as important. The skin loses its elasticity as a result of the sclerosis and is then more prone to injury and providing an entry point for micro-organisms in this densely colonized area.
The skin is relieved by consistent application of water free oil based care products, which reduce inflammatory reactions and damage to the epithelium; furthermore, it helps to limit the amount of corticosteroid that is required. Unfortunately this is a little known fact with regard to the anogenital region.
Prof. Dr. med. Eiko E. Petersen
Conflict of interest statement
Professor Petersen has received honoraria for speaking or continuing medical educational events from Bayer, Taurus, Essex Pharma, Kaymogyn, and Grünenthal.
|1.||Petersen EE: Farbatlas der Vulvaerkrankungen. Freiburg: Kaymogyn GmbH 2004.|
|2.||Becker K: Lichen sclerosus in boys. Dtsch Arztebl Int 2011; 108(4): 53–8. VOLLTEXT|