Lichen sclerosus: A review of the literature
More details
Hide details
Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Institute of Optoelectronics, Military University of Technology, Warszawa, Poland
Submission date: 2020-01-03
Final revision date: 2020-09-18
Acceptance date: 2020-09-18
Online publication date: 2020-11-04
Corresponding author
Marta Kasprowicz-Furmańczyk   

Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Wojska Polskiego 30, 10-229 Olsztyn, Poland. Tel.: +48784092806.
Pol. Ann. Med. 2020;27(2):230-237
Lichen sclerosus (LS) is a chronic inflammatory dermatosis which may lead to scarring and atrophy of the tissues. It has predilection for the skin and mucoses of anogenital area in men, women and children. The extragenital lesions occur less frequently. The most common symptoms are itching, pain and dyspareunia. The true prevalence of this disease is unknown and probably underestimated due to the underdiagnosis. Therapy of LS often causes many difficulties.

The aim of our review of the literature is to discuss the diagnostic and therapeutic difficulties of LS that may come across doctors of various specializations. We reviewed the literature regarding the etiology, clinical, medical and surgical management of LS.

Material and methods:
We performed a comprehensive research of the literature in PubMed, Medline and other electronic databases between 1956–2019 using the key words: ‘lichen sclerosus,’ ‘balanitis xerotica obliterans,’ ‘kaurosis vulvae.’ We reviewed 54 articles.

Results and discussion:
The clinical features and the management vary depending on the age and sex of the patient. To properly treat and prevent possible complications of LS, an interdisciplinary approach to patients care and timely diagnosis of the disease are extremely important. The essence of treatment is to control symptoms, prevent and treat complications and search for early signs of cancer.

LS is a disease that presents numerous challenges for doctors specializing in dermatology, gynecology, urology and pediatrics. An interdisciplinary approach is crucial to achieve therapeutic success and patient’s satisfaction.

None declared.
None declared.
Tasker GL, Wojnarowska F. Lichen sclerosus. Clin Exp Dermatol. 2003;28(2):128–133.
Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet. 1999;353(9166):1777–1783.
Kirtschig G. Lichen sclerosus – Presentation, diagnosis and management. Dtsch Arztebl Int. 2016;113(19):337–343.
Kirtschig G, Becker K, Günthert A, et al. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatology Venereol. 2015;29(10):e1–e43.
Harrington CI, Dunsmore IR. An investigation into the incidence of autoimmune disorders in patients with lichen sclerosus and atrophicus. Br J Dermatol. 1981;104(5):563–566.
Birenbaum DL, Young RC. High prevalence of thyroid disease in patients with lichen sclerosus. J Repr Med Obstet Gynecol. 2007;52(1):28–30.
Edmonds E, Barton G, Buisson S, et al. Gene expression profiling in male genital lichen sclerosus. Int J Exp Pathol. 2011;92(5):320–325.
Oyama N, Chan I, Neill SM, et al. Autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Lancet. 2003;362(9378):118–123.
Lowenstein EB, Zeichner JA. Intralesional adalimumab for the treatment of refractory balanitis xerotica obliterans. JAMA Dermatology. 2013;149(1):23–24.
Hofer MD, Meeks JJ, Mehdiratta N, Granieri MA, Cashy J, Gonzalez CM. Lichen sclerosus in men is associated with elevated body mass index, diabetes mellitus, coronary artery disease and smoking. World J Urol. 2014;31(2):105-108.
Jeffcoate TNA. Chronic vulval dystrophies. Am J Obstet Gynecol. 1966;95(1):61–74.
Panet-Raymond G, Girard C. Lichen sclerosus et atrophicus. Can Med Assoc J. 1972;106(12):1332–1334.
Clark JA, Muller SA. Lichen sclerosus et atrophicus in children: A report of 24 cases. Arch Dermatol. 1967;95(5):476–482.
Friedrich EG. Vulvar dystrophy. Clin Obstet Gynecol. 1985;28(1):178–187.
Ditkowsky SP, Falk AB, Baker N, Schaffner M. Lichen sclerosus et atrophicus in childhood. AMA J Dis Child. 1956;91(1):52–54.
Török E, Orley J, Gorácz G, Daróczy J. Lichen sclerosus et atrophicus in children. Clinical and pathological analysis of 33 cases. Mod Probl Paediatr. 1975;17:262–271.
Edmonds E, Mavin S, Francis N, Ho-Yen D, Bvunker C. Borrelia burgdorferi is not associated with genital lichen sclerosus in men. Br J Dermatol. 2009;160(2):459–460.
Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: An update. Am J Clin Dermatol. 2013;14(1):27–47.
Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018;178(4):839–853.
Zendell K, Edwards L. Lichen sclerosus with vaginal involvement: Report of 2 cases and review of the literature. JAMA Dermatology. 2013;149(10):1199-1202.
Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: Review of the literature and current recommendations for management. J Urol. 2007;178(6):2268–2276.
Powell J, Wojnarowska F. Childhood vulvar lichen sclerosus the course after puberty. J Repr Med Obstet Gynecol. 2002;47(9):706–709.
Warrington SA, De San Lazaro C. Lichen sclerosus et atrophicus and sexual abuse. Arch Dis Child. 1996;75(6):512–516.
Liatsikos EN, Perimenis P, Dandinis K, Kaladelfou E, Barbalias G. Lichen sclerosus et atrophicus: Findings after complete circumcision. Scand J Urol Nephrol. 1997;31(5):453–456.
Christman MS, Chen JT, Holmes NM. Obstructive complications of lichen sclerosus. J Pediatr Urol. 2009;5(3):165–169.
Mattioli G, Repetto P, Carlini C, Granata C, Gambini C, Jasonni V. Lichen sclerosus et atrophicus in children with phimosis and hypospadias. Pediatr Surg Int. 2002;18(4):273–275.
Ramrakha-Jones VS, Paul M, McHenry P, Burden AD. Nail dystrophy due to lichen sclerosus? Clin Exp Dermatol. 2001;26(6):507–509.
Micheletti L, Preti M, Radici G, et al. Vulvar lichen sclerosus and neoplastic transformation: A retrospective study of 976 cases. J Low Genit Tract Dis. 2016;20(2):180–183.
Walkden V, Chia Y, Wojnarowska F. The association of squamous cell carcinoma of the vulva and lichen sclerosus: Implications for management and follow up. J Obstet Gynaecol (Lahore). 1997;17(6):551–553.
Vilmer C, Cavelier-Balloy B, Nogues C, Trassard M, Le Doussal V. Analysis of alterations adjacent to invasive vulvar carcinoma and their relationship with the associated carcinoma: A study of 67 cases. Eur J Gynaecol Oncol. 1998;19(1):25–31.
Velazquez EF, Cubilla AL. Lichen sclerosus in 68 patients with squamous cell carcinoma of the penis: Frequent atypias and correlation with special carcinoma variants suggests a precancerous role. Am J Surg Pathol. 2003;27(11):1448–1453.
Powell J, Robson A, Cranston D, Wojnarowska F, Turner R. High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol. 2001;145(1):85–89.
Dalal V, Kaur M, Rai C, Singh A, Ramesh V. Histopathological spectrum of lichen sclerosus Et atrophicus. Indian J Dermatopathol Diagn Dermatol. 2017;4(1):8–13.
Peterson LS, Nelson AM, Su WP. Classification of morphea (localized scleroderma). Mayo Clin Proc. 1995;70(11):.
Lutz V, Francès C, Bessis D, et al. High frequency of genital lichen sclerosus in a prospective series of 76 patients with morphea: toward a better understanding of the spectrum of morphea. Arch Dermatol. 2012;148(1):24–28.
Kreuter A, Wischnewski J, Terras S, Altmeyer P, Stücker M, Gambichler T. Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center. J Am Acad Dermatol. 2012;67(6):1157–1162.
Wright JE. The treatment of childhood phimosis with topical steroid. Aust N Z J Surg. 1994;64(5):327–328.
Mazdisnian F, Degregorio F, Mazdisnian F, Palmieri A. Intralesional injection of triamcinolone in the treatment of lichen sclerosus. J Reprod Med. 1999;44(4):332–334.
Cattaneo A, Carli P, De Marco A, et al. Testosterone maintenance therapy: Effects on vulvar lichen sclerosus treated with clobetasol propionate. J Reprod Med. 1996;41(2):99–102.
Sadowska-Przytocka A, Dańczak-Pazdrowska A, Szewczyk A, et al. Treatment of genital lichen sclerosus in women - Review. Ginekol Pol. 2012;83(6):458–461.
Kulkarni S, Barbagli G, Kirpekar D, Mirri F, Lazzeri M. Lichen sclerosus of the male genitalia and urethra: Surgical options and results in a multicenter international experience with 215 patients. Eur Urol. 2009;55(4):945–956.
Meuli M, Briner J, Hanimann B, Sacher P. Lichen sclerosus et atrophicus causing phimosis in boys: A prospective study with 5-year followup after complete circumcision. J Urol. 1994;152(3):987–989.
Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000;86(4):459–465.
Hrebinko RL. Circumferential laser vaporization for severe meatal stenosis secondary to balanitis xerotica obliterans. J Urol. 1996;156(5):1735–1736.
Windahl T, Hellsten S. Carbon dioxide laser treatment of lichen sclerosus et atrophicus. J Urol. 1993;150(3):868–870.
Kalka K, Merk H, Mukhtar H. Photodynamic therapy in dermatology. J Am Acad Dermatol. 2000;42(3):389–413.
Kwaśny M. Photodynamic therapy in dermatology. For Dermatol. 2018;4:138–147 [in Polish].
Zawislak AA, McCluggage WG, Donnelly RF, et al. Response of vulval lichen sclerosus and squamous hyperplasia to photodynamic treatment using sustained topical delivery of aminolevulinic acid from a novel bioadhesive patch system. Photodermatol Photoimmunol Photomed. 2009;25(2):111–113.
Olejek A, Kozak-Darmas I, Kellas-Sleczka S, et al. Effectiveness of photodynamic therapy in the treatment of Lichen sclerosus: Cell changes in immunohistochemistry. Neuro Endocrinol Lett. 2009;30(4):547–551.
Olejek A, Steplewska K, Gabriel A, et al. Efficacy of photodynamic therapy in vulvar lichen sclerosus treatment based on immunohistochemical analysis of CD34, CD44, myelin basic protein, and Ki67 antibodies. Int J Gynecol Cancer. 2010;20(5):879–887.
Tedesco M, Pranteda G, Chichierchia G, et al. The use of PRP (platelet-rich plasma) in patients affected by genital lichen sclerosus: clinical analysis and results. J Eur Acad Dermatol Venereol. 2019;33(2):e58–e59.
Beattie PE, Dawe RS, Ferguson J, Ibbotson SH. UVA1 phototherapy for genital lichen sclerosus. Clin Exp Dermatol. 2006;31(3):343–347.
Windahl T. Is carbon dioxide laser treatment of lichen sclerosus effective in the long run? Scand J Urol Nephrol. 2006;40(3):208–211.
Ruan L, Xie Z, Wang H, Jiang J, Shi H, Xu J. High-intensity focused ultrasound treatment for non-neoplastic epithelial disorders of the vulva. Int J Gynecol Obstet. 2010;109(2):167–170.
Journals System - logo
Scroll to top