Definition
Lichen sclerosus, popularly known as scleroatrophic lichen, identifies a morbid inflammatory process of a chronic sclerotic nature, involving the skin and mucous membranes. Unfortunately, it is not uncommon for lichen sclerosus to be misdiagnosed, minimized or, even worse, underestimated: it is in fact a potentially pre-cancerous immunological inflammation. The scleroatrophic lichen can ideally affect every district of the organism, although it frequently occurs (in 83% of cases) in the male and female genital tissues.
Incidence
Lichen sclerosus, a variant of lichen planus, is a very widespread disease among the global population (estimated incidence index 3-15%), despite little discussion; some scientific texts believe that the disease is mainly female, but from recent statistical analyzes , it appears that lichen sclerosus affects both men and women equally.
Men are more prone to lichen sclerosus as they age; pre-menopausal women seem to be more susceptible to anogenital lichen sclerosus than girls.
The disease can also occur among infants, particularly among females: when we compare adult and childhood lichen sclerosus, the chances of complete recovery, without chronic complications, increase significantly in children. Furthermore, it has been found that during puberty lichen sclerosus is even more easily treatable: in this regard, a possible "protective" function of sex hormones has been hypothesized.
Lichen sclerosus occurs mainly among uncircumcised males: it is estimated that inflammation is diagnosed in 3.6-19% of removed foreskins [taken from Clinical Andrology, by Wolf-Bernhard Schill, Frank H. Comhaire, Timothy B. Hargreave ].
Lichen sclerosus in women
Although it can also affect extra-genital sites (arms, legs, trunk, tongue and oral mucous membranes), lichen sclerosus most frequently affects the female genitals (ano-vulvar scleroatrophic lichen): it is an inflammatory form that generally causes itching, burning and dyspareunia, and it could degenerate to the point of merging the small and large labia of the woman. It would be advisable to undergo periodic checks to monitor the disease, especially when the woman complains of lacerations or hyperkeratotic (thickened) areas at the genital level; scleroatrophic lichen causes a consistent and annoying dryness of the vaginal and perianal mucosa, accompanied by local irritation, white spots, fissures and shrinking or destruction of the labia minora.
As we have analyzed, lichen sclerosus could be an indication of a pre-neoplastic form such as, for example, vulvar epidermoid carcinoma: precisely for this reason, prophylaxis and periodic check-ups of the disease are essential.
Lichen sclerosus in humans
The older the man, the more he runs the risk of contracting lichen sclerosus; however, the male form of the disease is known as preputial balan lichen sclerosus. The genitals have obvious shiny white-brownish patches, associated with abrasions, micro-lesions, itching. , penodynia (male variant of female vulvodynia), pain and possible burning sensation during intercourse (dyspareunia). In addition, the disease may cause urethritis, urethral stricture, tight phimosis and difficulty in sliding the preputial sheet over the balanum (glans). scleroatrophic lichen, as the term itself suggests, could degenerate and cause a slow but progressive sclerotic scarring of the foreskin, glans and urethra.
Often times, unfortunately, lichen sclerosus is misdiagnosed, consequently even the therapy is not suitable: it is not uncommon, in fact, that the affected male patient has tried to treat the disorder with inappropriate drugs for supposed fungal infections.
Self-diagnosis is certainly not the best option, although it may apparently be the simplest: for men, in particular, genital disorders represent decidedly embarrassing problems, therefore the visit to the andrologist is often considered too late. lichen sclerosus is a potentially dangerous disease, which sometimes hides balanitis, postiti or balanoposthitis, other times unknown infections, or even severe precancerous forms: in this regard, it is necessary to consult a doctor from the very first symptoms.
Lichen sclerosus degeneration in humans:
Involvement of the foreskin → involvement of the glans → urethritis → urethral stricture → squamous carcinoma of the penis
[taken from www.ildermatologorisponde.it/].
Lichen sclerosus in children
Generally, lichen sclerosus that affects infants only rarely does not have a good prognosis: in fact, most of the time, the girl complains of itching or burning in the vulvar, perianal, while the affected child presents a "generalized genital irritation very similar to effects caused by balanoposthitis, sometimes related to phimosis (narrowing of the preputial leaflet).
Related diseases
Although the triggering causes, responsible for the manifestation of lichen sclerosus, have not yet been identified, some associated diseases and potential (but not fully demonstrated) risk factors have been observed: dyslipidemia, chronic infections in general, vitiligo, pernicious anemia , lupus erythematosus, diabetes mellitus, spino cell carcinoma of the penis. Psychophysical stress also seems to play a fundamental role in the onset of the disease
[taken from www.latuapelle.org].
Therapy
Medical treatment is absolutely fundamental to redeem the patient from lichen sclerosus: it should be pointed out that, generally, a multidisciplinary approach is necessary, therefore the patient should undergo several clinical trials to get a complete picture of the disease. The dermatologist is recommended. the gynecologist / urologist, and other specialists, depending on the severity of the disease.
The most recommended therapies are based on the administration of pharmaceutical specialties with systemic action (eg immunosuppressants, corticosteroids) and topical applications (eg antioxidants). Unfortunately, however, especially in the male, the disorder could be recognized late because the patient tends to postpone the visit: when underestimated, the lichen sclerosus could degenerate, so the only solution remains the surgical operation (circumcision). [taken from www.latuapelle.org].
In some patients, carbon dioxide laser therapy is recommended, together with the topical application of antibacterial substances, in the event that lichen sclerosus is favored by infections.
[taken from Clinical Andrology, by Wolf-Bernhard Schill, Frank H. Comhaire, Timothy B. Hargreave].
Summary
Lichen sclerosus in brief:
Lichen sclerosus (or scleroatrophic lichen)
Morbid inflammatory process of a chronic sclerotic nature, involving the skin and mucous membranes
Ideally: it can affect the whole skin
83% of cases: involves the genitals
- Estimated incidence index 3-15%
- Especially female disease
- Humans are more prone to lichen sclerosus as they age
- The disease can also occur in infants
- Lichen sclerosus occurs mainly among uncircumcised males
- During puberty, lichen sclerosus is even more easily treatable
Lichen sclerosus in women (ano-vulvar scleroatrophic lichen):
- It frequently affects the female genitals
- It causes itching, burning, dyspareunia
- Possible fusion of the labia minora and labia majora
- Formation of lacerations or hyperkeratotic (thickened) areas at the genital level
- Possible local irritation, white spots, fissures, shrinking or destruction of the labia minora, dryness of the vaginal and perianal mucosa
Lichen sclerosus in humans (preputial lichen sclerosus balanus) could cause:
- shiny white-brownish patches, associated with abrasions, micro-lesions, itching, penodynia
- sclerotic scarring of the foreskin, glans, urethra
- urethritis, urethral stricture, tight phimosis and difficulty in sliding the preputial sheet on the barnacle
- pain and possible burning sensation during intercourse
The girl: complains of itching or burning in the vulvar and perianal
The affected child has "general genital irritation."
Dysplidemia, chronic infections in general, vitiligo, pernicious anemia, lupus erythematosus, diabetes mellitus, spino cell carcinoma of the penis
- immunosuppressants, corticosteroids
- antioxidants
- circumcision
- laser therapy
- topical application of antibacterial substances
Other articles on "Lichen Sclerosus"
- Lichen Ruber Planus
- Lichen Planus
- Lichen Planus: therapeutic strategies
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