presentation and is preferably confirmed with histologic features of a 3-mm punch biopsy. 3 Several other disorders that present with vulvar pruritus and/or similar presentations need to be considered when diagnosing this condition. [clinicaladvisor.com]

We describe an unusual presentation of lichen sclerosus in a postmenarchal, virginal girl. [ncbi.nlm.nih.gov]

• Pain

  An inhaled 50% nitrous oxide/oxygen premix was administered during sessions, producing a pain-relieving, anxiolytic, and sedative effect without loss of consciousness. [ncbi.nlm.nih.gov]

  Symptomatic lichen sclerosus may cause an itching feeling, pain during urination, or pain during intercourse. You may also experience bleeding and blisters in the perineal area.... [web.archive.org]

  Sex is often painful, less pleasurable, or impossible because of the pain. Lichen sclerosus in men and boys may cause tightening of the foreskin, leading to difficulty in passing urine or painful erection. [cochrane.org]

  Some men with lichen sclerosus have painful erections. In women, lichen sclerosis generally appears on the vulva (the area around the vagina). Itching may be especially bothersome at night. [issm.info]

  dysuria, and constipation with pain on defecation, may be chronic and are often disruptive. [doi.org]

• Burning Pain

  There were no differences between pimecrolimus and clobetasol propionate in relieving symptoms through change in pruritus (SMD -0.33 [95% CI -0.99 to 0.33]) and burning/pain (SMD 0.03 [95% CI -0.62 to 0.69]). [ncbi.nlm.nih.gov]

  9.1 ), change in burning/pain (SMD 0.03, 95% CI ‐0.62 to 0.69) (see Analysis 9.2 ). [doi.org]

  Affected women and girls frequently report itching, pain, and burning in the involved area. Scarring after inflammation may cause fusion of the vaginal lips, narrowing of the vaginal opening, and burying of the clitoris. [cochrane.org]

  Women consult doctor after doctor seeking a diagnosis for their private burning pain. Many have been repeatedly treated for non-existent yeast infections, which can exacerbate the pain. [nva.org]

• Surgical Procedure

  Treatment of the latter and short follow-up of the patients, can avoid over-diagnosis of malignancies and extensive surgical procedures. [ncbi.nlm.nih.gov]

  Risk Factors Menopause, trauma (due to chronic friction and scratching), urogenital surgical procedures or sexual abuse during childhood, and infections (vulvitis/urethritis) are considered risk factors for the development of LS. [unboundmedicine.com]

  Procedures, Interventional Radiology and Emergency Centre Clinical Ethics Committee Consumer involvement Community consultation ACT’s Mental Health Act 2015 Health Practitioner Regulation National Law National Code of Conduct for Health Care Workers [health.act.gov.au]

• Falling

  […] and Falls Injury Prevention Program Social Work – Aged Care Inpatient Services Transitional Therapy and Care Program Alcohol and Drug Services Our Services Consultation Liaison Services Counselling and treatment service Diversion services Needle and [health.act.gov.au]

  Like YES WB, it is a water-based and pH matched translucent gel that is bio-adhesive to allow it to soothe damaged tissues and release moisture where needed while avoiding any unpleasant ‘fall-out’. YES VM is also available via NHS prescription. [yesyesyes.org]

  Ein Fall von mit weissen Flecken einhergehender, bisher nicht bekannter Dermatose. Monatschr Prakt Dermatol 1901; 33: 355–61 Google Scholar 13. von Zumbusch LR. Über Lichen albus, eine bisher unbeschriebene Erkrankung. [doi.org]

  Über einen fall von Kraurosis penis bei gleichzeitigem Bestehen von Weissflecken am Skrotum. Dermatol Wochnschr 1928; 86: 7. Mackee GM, Wise F. White spot disease. J Cutan Dis 1914; 32: 629-60. Laymon CW. [cirp.org]

• Pruritus

  Intense and recalcitrant pruritus is a symptomatic hallmark of LS. [liebertpub.com]

  Micheline Moyal-Barracco, Pruritus Vulvae, Pruritus, 10.1007/978-1-84882-322-8_37, (243-252), (2009). Paul D. [doi.org]

  Biopsy of suspected vulvar lichen sclerosus in adults is preferred during the initial visit rather than after empiric therapy because of: the risk for atypia or malignancy; the expansive list of possible differentials associated with vulvar pruritus and [clinicaladvisor.com]

  Lichen sclerosus can be debilitating for some patients causing significant pruritus, pain, dysuria, and dyspareunia [4]. Rarely, lichen sclerosus appears in various extragenital areas, although most cases are relatively asymptomatic [3]. [ncbi.nlm.nih.gov]

  When properly administered, topical ultra-potent corticosteroids help to resolve the symptoms of pruritus and burning and can prevent further vulvar scarring. [clinicaltrials.gov]

• Skin Disease

  Lichen sclerosus (LS) is a benign, chronic, inflammatory skin disease with a predilection for the anogenital region in women. [ncbi.nlm.nih.gov]

  In this case, the skin disease is only discovered during a routine check-up. [naspag.org]

• Dermatitis

  Genital wart is the most common sexually transmitted disease caused by human papilloma viruses and vulval lichen sclerosus is chronic pruritic dermatitis in genital area which could be able to change to invasive squamous cell carcinoma. [ncbi.nlm.nih.gov]

  […] literature they found that names which had been applied to this disease included lichen planus sclerosus et atrophicus, lichen planus morphoeicus, white spot disease, Unna's card-like scleroderma, lichen albus of von Zumbusch, and chronic atrophic lichenoid dermatitis [doi.org]

  A short-term trial of tacrolimus ointment for atopic dermatitis. N Engl J Med. 1997;337816- 821 PubMed Google Scholar Crossref 12. Reitamo SWollenberg ASchopf E et al. [jamanetwork.com]

• Blister

  The earliest signs are skin fragility, bruising, and sometimes blistering. Lesions typically cause mild to severe itching. When lichen sclerosus manifests in children, the appearance may be confused with sexual abuse. [msdmanuals.com]

  Some of these lesions evolved with hemorrhagic blisters, which after histopathological examination confirmed the diagnosis of bullous and hemorrhagic lichen sclerosus. [ncbi.nlm.nih.gov]

  Blisters and bleeding may also occur. Lichen sclerosus starts out as small white spots on the skin. These spots are generally shiny and smooth. The spots then grow into larger patches that are thin and crinkled. [web.archive.org]

• Hyperkeratosis

  Criteria evaluated included hyperkeratosis, epidermal atrophy, follicular plugging, basal cell vacuolation, vascular ectasia, hyalinosis, inflammatory infiltrate, dermal edema, and fibrosis. [ijdpdd.com]

  A punch biopsy from an atrophic plaque was performed, and it revealed hyperkeratosis, atrophic epidermis, basal layer vacuolar degeneration, mild lymphocytic infiltration in the dermis, edema, and homogenization of collagen of the upper portion of the [ncbi.nlm.nih.gov]

  Hyperkeratosis, epidermal atrophy, a swollen dermal collagen bundle, and prominent edema was evident (B) (H&E, original magnification ×200). [mdedge.com]

  Clitoris becomes buried under clitoral hood Gross description Atrophic skin resembles cigarette paper (crinkly atrophy); often with loss of labia Also white / red ill defined patches No vaginal involvement Microscopic (histologic) description Severe hyperkeratosis [pathologyoutlines.com]

• Burning Sensation

  Itching, pain and burning sensations and atrophy of vulva impair quality of life. Treatment is symptomatic. We report case of 30-year old woman with lesions in vulva in which series of topical PDT were carried out. [ncbi.nlm.nih.gov]

  Side effects include burning, irritation, dryness, flaking, discoloration and thinning of the skin, but doctors report the main side effect is a short-term burning sensation. [healthywomen.org]

  For half of the women, it was asymptomatic; the other half suffered from vulvar pruritus or a burning sensation. [academic.oup.com]

  The 3 prepubertal girls experienced a slight burning sensation for several minutes on applying the ointment. These minor adverse effects subsided within a few days. There were no signs of atrophy at any treated site ( Table 1 ). [jamanetwork.com]

  She was examined 5 weeks after initiation of the treatment, and application of the topical corticosteroid was discontinued because the signs of lichen sclerosus had almost cleared despite the burning sensation. [doi.org]

• Dyspareunia

  Lichen sclerosus can be debilitating for some patients causing significant pruritus, pain, dysuria, and dyspareunia [4]. Rarely, lichen sclerosus appears in various extragenital areas, although most cases are relatively asymptomatic [3]. [ncbi.nlm.nih.gov]

  The atrophy, strictures, and scarring of the affected genitalia secondary to vulvar lichen sclerosus often result in sexual dysfunction, specifically dyspareunia. 7 These anatomical changes may also lead to decreased lubrication and decreased sensation [clinicaladvisor.com]

  Despite adequate treatment, women with lichen sclerosus continue to experience significant sexual dysfunction (i.e., dyspareunia, decreased orgasm and decreased coital frequency). [cancertherapyadvisor.com]

• Genital Lesions

  We describe a patient with skin, oral and genital lesions of lichen sclerosus. [ncbi.nlm.nih.gov]

  Genital lesions were commonly seen on the vulva and prepuce [Figure 2]. [ijdpdd.com]

  Alberto Rosenblatt, Homero Gustavo de Campos Guidi and Walter Belda, Premalignant Lesions of the Penis, Male Genital Lesions, 10.1007/978-3-642-29017-6_16, (375-401), (2012). [doi.org]

  Genital lesions in women. In: Taylor and Kelly's Dermatology for Skin of Color. 2nd ed. McGraw Hill; 2016. https://accessmedicine.mhmedical.com. Accessed July 25, 2022. Cooper SM, et al. [mayoclinic.org]

• Dysuria

  Lichen sclerosus can be debilitating for some patients causing significant pruritus, pain, dysuria, and dyspareunia [4]. Rarely, lichen sclerosus appears in various extragenital areas, although most cases are relatively asymptomatic [3]. [ncbi.nlm.nih.gov]

  Pruritus, chronic discomfort, dysuria, and pain with defecation were common chief complaints in our patients. [doi.org]

  If there is meatal scarring, poor urinary stream or dysuria. Signs: White patches on the glans or prepuce. Haemorrhagic vesicles or purpura. Rarely, blisters or ulcers. [patient.info]

• Pruritus Vulvae

  Micheline Moyal-Barracco, Pruritus Vulvae, Pruritus, 10.1007/978-1-84882-322-8_37, (243-252), (2009). Paul D. [doi.org]

  Lichen sclerosus can be extremely itchy and sore ( pruritus vulvae ). Sometimes bruises, blood blisters and ulcers appear after scratching, or from minimal friction (eg tight clothing, sitting down). Urine can sting and irritate. [dermnetnz.org]

On further workup, there was no evidence of disseminated disease involving other organs. [ncbi.nlm.nih.gov]

No significant effect of treatment duration on time to relapse was found. [doi.org]

This study will consist of a two-week screening period and a 12-week treatment period. [clinicaltrials.gov]

Prognosis Prognosis is good for more acute genital cases of lichen sclerosus (LS), especially for those in the pediatric age group, in whom it may resolve spontaneously. [emedicine.medscape.com]

Etiology and Pathophysiology The etiology of LS is unknown. Some studies have shown a link between autoimmune diseases and LS in women, whereas this association in men has not been analyzed to the same extent. [unboundmedicine.com]

Lichen sclerosus et atrophicus is a chronic disease of unknown etiology characterized by atrophic and sclerotic plaques in both genital and extragenital regions. [ncbi.nlm.nih.gov]

Meijer, Penile cancer: epidemiology, pathogenesis and prevention, World Journal of Urology, 10.1007/s00345-008-0302-z, 27, 2, (141-150), (2008). [doi.org]

Epidemiology Incidence LS is a rare entity. Occurs at all ages and in both genders, but a higher incidence is present in postmenopausal women. The male-to-female ratio varies between 1:3 and 1:10. [unboundmedicine.com]

Material and methods We report 20 patients undergoing circumcision due to histologically confirmed lichen sclerosus, in whom we analysed demographic, clinical and analytical characteristics to complete an epidemiological profile of patients with this [elsevier.es]

A review of this case and the literature describes the clinical features, pathophysiology, and treatment options for this extragenital bullous variant in an effort to raise awareness of this rare clinical presentation. [ncbi.nlm.nih.gov]

Etiology and Pathophysiology The etiology of LS is unknown. Some studies have shown a link between autoimmune diseases and LS in women, whereas this association in men has not been analyzed to the same extent. [unboundmedicine.com]

Spiess, Understanding the Pathophysiology of Penile Cancer and Its Preneoplastic Lesions, Penile Cancer, 10.1007/978-1-4939-6679-0_1, (1-11), (2016). [doi.org]

Complications include pain, sexual and/or urinary dysfunction, reduced quality of life, and an increased risk of squamous cell carcinoma ( Pathophysiology Inflammation and altered fibroblast function in the papillary dermis lead to fibrosis of the upper [emedicine.medscape.com]

General Prevention No clear preventive methods are reported in the current guideline; however, early aggressive treatment may prevent disease progression. Commonly Associated Conditions 20–30% of women with LS also have autoimmune diseases. [unboundmedicine.com]

The only predictor we have identified is a lack of consistent preventive treatment. [doi.org]

While treatment can prevent further changes in genital tissue, any scarring that has already occurred is not reversible without surgery. [drexelmedicine.org]

Every other month or greater, injection intervals were required to prevent relapse in all patients. [liebertpub.com]

Strong topical steroid medication is prescribed to control inflammation, help smooth out the roughened skin, and prevent or halt scarring. However it cannot reverse loss of skin architecture. [mshc.org.au]