Lichen Sclerosus Mucosal Findings
On mucosal surfaces, papules are fragile, atrophic, white, and glistening with a wrinkled surface. Male genital lichen sclerosus is referred to as balanitis xerotica obliterans. Penile lesions favor the glans and coronal sulcus, but may extend to the shaft. Surface trauma leads to focal subepidermal hemorrhages and erosions. Atrophy leads to phimosis of the foreskin with pain on retraction of the foreskin or erection. The urethral meatus may become stenotic, and malignant degeneration may occur.
Vulvar papules tend to coalesce, forming a white atrophic plaque with an hour-glass shape, which encircles the vagina and anus. Focal purpura is common as are mucosal erosions. Itching is the most frequent complaint which may be severe enough to interfere with sleep or daily activities. Scratching may lead to secondary infection and lichenification among areas of atrophy. Atrophy and scarring can lead to shrunken and fused tissues obliterating normal anatomic structures. Secondary candidiasis can occur as a consequence of treatment with topical steroids and a potassium hydroxide examination should be considered.
Purpura of the vulva is an occasional manifestation of lichen sclerosus in prepubescent girls.
This may be misdiagnosed as child abuse, thus lichen sclerosus should be carefully ruled out in such cases. Prepubertal cases usually resolve without sequelae, other than hyperpigmentation.