FFinalistSouthampton · 2027
Obstetrics & gynaecology
AKT · Obstetrics & gynaecology/Menopause & vulval

Lichen sclerosus

Chronic inflammatory dermatosis (autoimmune-associated)

Overview

A chronic inflammatory skin condition, commonest on the anogenital skin of postmenopausal women, causing intense itch and white atrophic plaques in a figure-of-eight distribution. Carries a small risk of vulval squamous cell carcinoma.

Recognise

  • Intense vulval/perianal ITCH (often worse at night)
  • White, atrophic, "parchment/cigarette-paper" plaques; figure-of-eight around vulva and anus
  • Architectural loss: fusion of labia, narrowing of introitus; fissuring

Red flags

  • Persistent ulcer/lump or thickened area → biopsy to exclude vulval squamous cell carcinoma

Differentials & how to tell them apart

Lichen planuscan erode mucosa (Wickham striae elsewhere), violaceous
Vulval cancerpersistent lump/ulcer — biopsy
Vitiligodepigmentation without atrophy/itch
Candidiasisdischarge, less architectural change

Investigations

Usually clinical; BIOPSY if diagnostic doubt or any suspicion of malignancy.

Management

Potent topical corticosteroid (clobetasol propionate)

  1. 1Potent topical corticosteroid (clobetasol propionate) in a tapering regimen + emollient/soap substitute.
  2. 2Maintenance steroid; biopsy and refer if not responding or any suspicion of malignancy.
Potent topical corticosteroid (clobetasol propionate) — first-line, e.g. tapering regimen
Emollients — soap substitutes

Key points

Small but real risk of vulval squamous cell carcinoma — long-term follow-up and biopsy of any non-resolving lesion. Strongly associated with autoimmune disease.

Monitor & prognosis

Response, architectural change, and for malignant transformation.

Controlled with steroids; needs surveillance.

Source: NICE CKS; BAD