Lichen sclerosus
Synonyms and keywords: Lichen sclerosus et athrophicus, white-spot disease; Lichen Sclerosis (LS); Lichen Sclerosus et Atrophicus (LSA); Balanitis xerotica obliterans (BXO); Csillag's disease; White Spot Disease; kraurosis vulvae; lichen albus and lichen sclerosus et atrophicans

# Overview
Lichen sclerosus (LS) (also known as lichen sclerosus et atrophicus (LSA), white-spot disease) is an uncommon disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin. 

# Historical Perspective
LS was first described in 1887 by Dr. Hallopeau.
In 1989 the International Society for the Study of Vulvovaginal Disease (ISSVD) officially proclaimed the name lichen sclerosus. Since then this is the official medical name for this disease.

# Classification

# Pathophysiology

# Causes

# Differentiating Lichen Sclerosus from other Diseases
Diagnosis needs sometime biopsy because LSA may be difficult to differentiate from condyloma. Histologically there's hyperkeratosis, atrophic epidermis, sclerosis of dermis and lymphocyte activity in dermis.

# Epidemiology and Demographics

## Age

## Gender
Women are more commonly affected than men, particularly around and after menopause, but girls may also get the disease.

## Race

# Risk Factors

# Natural History, Complications and Prognosis
LS may cause sufferers to feel depressed due to their condition, due to the pain caused and feelings that they are 'not normal', 'can't have sex properly', 'the only one like this' and other self-esteem issues. It may be useful for them to contact other sufferers and speak to them, to see they are not alone and since they may understand what they are feeling better than non-sufferers, or speak a counsellor to work through any issues. Support groups exist for sufferers who may be able to help in this respect, one example is the National Lichen Sclerosus Support Group which is based in the UK, but does have an international membership. Their website also contains a lot of useful information on Lichen Sclerosis, its symptoms and its treatment.
The disease can last for a long time. Occasionally, spontaneous cure may ensue, particularly in young girls.
When it occurs on the vulva, it leads in 1-4 % of cases to vulvar carcinoma. For men it might be a major cause for tight foreskin, phimosis.

# Diagnosis

## Diagnostic Criteria

## Symptoms

## Physical Examination
In males, the disease may take the form of whitish thickening of the foreskin, which cannot be retracted easily. One study has revealed that 51 (98%) of 52 patients diagnosed with penile LS were uncircumcised.  In men, this genital involvement has traditionally been known as balanitis xerotica obliterans (BXO).
On the non-genital skin, the disease may manifest as porcelain-white spots with small visible plugs inside the orifices of hair follicles or sweat glands on the surface. Thinning of the skin may also occur.

### Skin
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.
- Lichen sclerosus et atrophicus. Adapted from Dermatology Atlas.

## Laboratory Findings

## Imaging Findings

## Other Diagnostic Studies

# Treatment

## Medical Therapy
LS is usually treated with application of potent steroids, which may cause relief and prevent scarring.   Other options are cryotherapy, and laser therapy. Occasionally, cancer may develop on the patches. Periodic consultation is therefore necessary.

## Surgery

## Prevention