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CASE REPORT
Year : 2007  |  Volume : 28  |  Issue : 1  |  Page : 40-42
 

Lichen sclerosus: A case report with review of literature


Department of Skin and VD, Govt. Medical College and SSG Hospital, Vadodara, India

Correspondence Address:
Y S Marfatia
Department of Skin and V.D., Govt. Medical College and SSG Hospital, Vadodara
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.35713

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   Abstract 

Lichen sclerosus is an uncommon disease of unknown etiology in which small white areas on the skin may be associated with an atrophic, potentially scarring condition of the perineum. A 45-year-old male patient presented with porcelain white atrophic plaques over shaft and glans penis, along with complaint of intense pruritus, painful penile erection and burning micturition. Presumptive diagnosis of lichen sclerosus was kept. Histopathological examination confirmed the diagnosis.


Keywords: Histopathological examination, lichen sclerosus


How to cite this article:
Shah R, Ghiya R, Iyer A, Marfatia Y S. Lichen sclerosus: A case report with review of literature. Indian J Sex Transm Dis 2007;28:40-2

How to cite this URL:
Shah R, Ghiya R, Iyer A, Marfatia Y S. Lichen sclerosus: A case report with review of literature. Indian J Sex Transm Dis [serial online] 2007 [cited 2019 Jun 25];28:40-2. Available from: http://www.ijstd.org/text.asp?2007/28/1/40/35713



   Introduction Top


Lichen sclerosus, also known as white spot disease or Csillag's disease, [1] is an idiopathic inflammatory dermatosis of unknown etiology clinically characterized by small, porcelain white, sclerotic lesions occurring at any site on genital and extra-genital areas. It is reported under a variety of other appellations such as lichen sclerosus et atrophicus, balanitis xerotica obliterans and kraurosis vulvae [2] (older description of vulval presentation). Lichen sclerosus (LS) is ten times more common in females and frequently affects postmenopausal females. Male genital lesions are usually confined to glans penis, prepuce or foreskin remnants. Penile shaft involvement is much less common. [2] It can be mistaken as vitiligo or lichen planus clinically.


   Case Report Top


A 45-year-old male presented with lesion over shaft and glans penis of 3 months' duration. He complained of intense pruritus, painful erection of penis and burning micturition. There was no history of high-risk sexual behavior. Past history of genital ulcer or discharge was ruled out. On examination, few porcelain white colored plaques with wrinkling were present over shaft and glans penis [Figure - 1]. Patient was uncircumcised. Associated meatal narrowing was noted [Figure - 2]. Scrotal and perianal areas were normal. There was no urethral discharge or genital scar. Inguinal lymph nodes were not palpable. On clinical grounds, lichen sclerosus, lichen planus, vitiligo, mucous membrane pemphigoid and Bowen's disease were considered differentials. Routine hemogram, liver function tests, renal function tests and random blood sugar were within normal range. Serum venereal disease research laboratory (VDRL) test and enzyme-linked immunosorbent assay (ELISA) for HIV I and II were negative. Biopsy was taken from the lesion to confirm the diagnosis. Histopathological examination showed thinning of epidermis with flat rete ridges, along with band of hyalinized dermal collagen below epidermis, characteristic of LS [Figure - 3]. He was given symptomatic treatment in the form of H-1 receptor antagonists and combination of 0.05% clobetasol propionate cream and 2% miconazole cream topically. He was also advised circumcision. On follow-up, symptomatic improvement was observed.


   Discussion Top


LS, also called lichen sclerosus et atrophicus, is a chronic inflammatory dermatosis that results in white plaques with epidermal atrophy affecting anogenital region most commonly and is more severe in adults, resulting in scars and stenosis. [2]

Etiology of LSA is unknown but several theories are postulated. Occasional finding of autoimmune antibodies and association with autoimmune disease suggests an autoimmune phenomenon. [3] A genetic basis for the disease is also suggested and is supported by increased incidence of HLA DQ 7, HLA BO8-B18 and familial occurrence. Role of  Borrelia burgdorferi Scientific Name Search i is controversial. [2] Anatomical abnormality (hypospadias) and trauma seem to be contributory factors. Itching with variable severity is the main symptom of Lichen Sclerosus. [3] Other symptoms include burning, bleeding, tearing, dyspareunia, phimosis, paraphimosis and constrictive ring adherent to glans. LS may also lead to urethral meatal stenosis, dysuria, urinary obstruction and possible damage to posterior urethra and even to bladder and kidney. Diagnosis is clinicopathological. Presence of white ring at tip of prepuce is diagnostic, and histopathological changes are typical. [4] Differential diagnosis includes balanitis circumscripta plasmacellularis, Bowen's disease of glans penis, extramammary paget's disease, discoid lupus erythematosus, idiopathic guttate hypomelanosis, lichen planus, morphea, squamous cell carcinoma, mucous membrane pemphigoid. [2] Symptomatic treatment with emollients and antipruritic medications (sedative antihistaminics) is helpful to control pruritus. Ultrapotent corticosteroid ointment in the form of clobetasol propionate applied initially once every night for 4 weeks followed by applying every alternate night for 4 weeks and then twice per week for 4 weeks controls pruritus. Secondary bacterial and candidial infection should be treated. Other modalities include testosterone ointment oral stanazolol, liquid nitrogen cryotherapy, CO 2 laser, ACTH, acitretin and isotretinoin. Surgery is indicated whenever medical treatment fails and includes circumcision, frenuloplasty, meatotomy and sophisticated plastic repair. [2] There is 4-9.5% increased risk of squamous cell carcinoma of penis. Effect of treatment on risk of carcinoma development is not known. Long-term follow-up is necessary if case is uncircumcised and if symptoms persist or recur after treatment. There are certain medicolegal pitfalls associated with this condition. Persistent ulcerated area unresponsive to therapy may be malignancy and can be missed if incomplete diagnosis without additional biopsies is done. Inappropriate surveillance can account for steroid side effects or spread of malignancy. Bullous and hemorrhagic or erosive LS may be confused with child abuse. Topical testosterone may not be more effective than placebo and can have the additional adverse effect of virilization. Topical therapy can lead to allergic/irritant contact dermatitis. [2]

 
   References Top

1.Available from: http://www.dermis.net/dermisroot/en/34088/diagnose.htm.  Back to cited text no. 1    
2.Meffert J. Lichen sclerosus et atrophicus. [Last updated on 2006 Dec 15]. Available from: http://www.emedicine.com/DERM/topic234.htm. [Last accessed on 2007 Jul 23].  Back to cited text no. 2    
3.Al-Khenaizan S, Almuneef M, Kentab O. Lichen sclerosus mistaken for child sexual abuse. Int J Dermatol 2005;44:317-20.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Vergara G, Betlloch I, Albares MP, Pascual JC, Guijarro J, Botella R, et al . Lichen sclerosus et atrophicus arising in urethrostomy scar. Int J Dermatol 2002;41:619-21.  Back to cited text no. 4    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures

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