Lichen-related vulvar disorders are a group of inflammatory-dystrophic conditions with diverse aetiologies. The recurrent nature of symptoms and often severe discomfort in the intimate area significantly affects women’s quality of life. This group of dermatoses includes: lichen planus, chronic simple lichen, and lichen sclerosus. They share a similar clinical picture, presenting as chronic vulvar complaints such as:
- pain,
- itching,
- pricking sensations,
- burning.
In the case of lichen sclerosus, additional symptoms may cause significant functional disturbances and sexual discomfort:
- scarring,
- narrowing of the vaginal introitus,
- fusion of the clitoral prepuce, and glans,
- atrophy of the labia minora.
Moreover, lichen sclerosus carries a risk of malignant transformation in chronically inflamed tissues, estimated at 2-6%, which increases with age and disease duration, necessitating lifelong surveillance1.
Lichen sclerosus is considered to have an autoimmune aetiology, as characteristic autoantibodies are found in 74% of patients2. These women often have other autoimmune diseases, e.g., thyroiditis, occurring in 12-16% of cases. Genetic predisposition may also play a role, as evidenced by reports in monozygotic twins and increased familial occurrence3,4. The mainstay of lichen sclerosus treatment is topical corticosteroids5,6,7. The primary goal of therapy is effective control of persistent symptoms and preservation of tissue function. Proper management also reduces the long-term risk of malignant transformation. Other therapeutic options include photodynamic therapy and ultraviolet light therapy, though there is currently no evidence these methods are superior to corticosteroid therapy or that they reduce the risk of malignancy8,9,10.
References
1 Bleeker MC, Visser PJ, Overbeek LI, van Beurden M, Berkhof J. Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma. Cancer Epidemiol Biomarkers Prev. 2016 Aug;25(8):1224-30. doi: 10.1158/1055-9965.EPI-16-0019. Epub 2016 Jun 2. PMID: 27257093.
2 Oyama N, Chan I, Neill SM, Hamada T, South AP, Wessagowit V, Wojnarowska F, D’Cruz D, Hughes GJ, Black MM, McGrath JA. Autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Lancet. 2003 Jul 12;362(9378):118-23. doi: 10.1016/S0140-6736(03)13863-9. PMID: 12867112.
3 Krapf JM, Mitchell L, Holton MA, Goldstein AT. Vulvar Lichen Sclerosus: Current Perspectives. Int J Womens Health. 2020 Jan 15;12:11-20. doi: 10.2147/IJWH.S191200. PMID: 32021489; PMCID: PMC6970240.
4 Cooper SM, Ali I, Baldo M, Wojnarowska F. The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case-control study. Arch Dermatol. 2008 Nov;144(11):1432-5. doi: 10.1001/archderm.144.11.1432. PMID: 19015417.
5 Nair PA. Vulvar Lichen Sclerosus et Atrophicus. J Midlife Health. 2017 Apr-Jun;8(2):55-62. doi: 10.4103/jmh.JMH_13_17. PMID: 28706405; PMCID: PMC5496281.
6 Doulaveri G, Armira K, Kouris A, Karypidis D, Potouridou I. Genital vulvar lichen sclerosus in monozygotic twin women: a case report and review of the literature. Case Rep Dermatol. 2013 Nov 7;5(3):321-5. doi: 10.1159/000356775. PMID: 24348381; PMCID: PMC3843921.
7 Lis-Święty A, Mierzwińska K, Wodok-Wieczorek K, Widuchowska M, Brzezińska-Wcisło L. Co-existence of lichen sclerosus and localized scleroderma in female monozygotic twins. J Pediatr Adolesc Gynecol. 2014 Dec;27(6):e133-6. doi: 10.1016/j.jpag.2013.11.010. Epub 2014 May 16. PMID: 24841519.
8 Lee A, Fischer G. Diagnosis and Treatment of Vulvar Lichen Sclerosus: An Update for Dermatologists. Am J Clin Dermatol. 2018 Oct;19(5):695-706. doi: 10.1007/s40257-018-0364-7. PMID: 29987650.
9 Lee A, Bradford J, Fischer G. Long-term Management of Adult Vulvar Lichen Sclerosus: A Prospective Cohort Study of 507 Women. JAMA Dermatol. 2015 Oct;151(10):1061-7. doi: 10.1001/jamadermatol.2015.0643. PMID: 26070005.
10 Swisher ED. Liszaj twardzinowy: dystrofia sromu z potencjałem zezłośliwienia. Ginekologia po Dyplomie. 2021 Nov; 6(23):68-74
