Side effects of testosterone include clitoral hypertrophy, hirsutism, and increased libido, and in patients who cannot tolerate these, progesterone may be used. Another treatment option is use of a topical corticosteroid, which has the additional benefit in patients with intense pruritus of providing immediate relief. Long-term steroid therapy has not been advocated in the past because of concerns over further atrophy of the skin and excessive absorption. Oral retinoids have been used for lichen sclerosus with some success. Like lichen sclerosus, squamous cell hyperplasia is a white lesion.
Inflammatory cells are present throughout the dermis.
Traditionally, fluorinated steroids have been chosen, but clobetasol is now receiving attention. Therefore, in lesions composed of areas of thinning and areas of hypertrophy, care should be taken to procure biopsy specimens from both sections to avoid misdiagnosis. There has long been concern over the malignant potential of lichen sclerosus and squamous cell hyperplasia. The risk of dysplasia is higher in lichen sclerosus complicated by squamous cell hyperplasia, presumably because of the chronic irritation and high cell turnover. Therefore, it is important to monitor patients with lichen sclerosus and squamous cell hyperplasia at regular intervals and to take biopsy samples of any changes in lesions.