This chapter is set out as follows: Aetiology History Clinical findings Images Investigations Management Other resources Aetiology The suspected prevalence varies between 0.1% and 3% for children and post-menopausal women respectively, and 0.07% for males The exact aetiology is unknown An autoimmune cause has been suggested as LS is commonly found alongside other autoimmune conditions LS can develop after an injury to the affected area (the Koebner phenomenon) History LS is six times more common in women than in men Although LS is most often seen in women around and after the time of the menopause , it can affect any age group - up to 15% of cases are in children with the majority affecting the vulva (a small percentage of boys present with phimosis) Non-genital lesions are often asymptomatic, whereas genital lesions are often itchy or sore, sometimes severely so Clinical findings Extra-genital lichen sclerosus LS can affect non-genital skin with or without genital involvement Lesions are generally asymptomatic Distribution A few to many lesions most commonly affecting the upper trunk and neck, the axillae, around the umbilicus, the wrists and other flexural sites Morphology Typical lesions are ivory or porcelain-white , shiny, polygonal macules or flat-topped papules Lesions may be pitted Many of the lesions coalesce to form larger patches-plaques Later on the lesions develop a characteristic wrinkled appearance Other features occasionally seen - thickened with a warty appearance, lichenification, bullae Non-genital LS is not associated with SCC The main differential diagnosis is Morphoea Anogenital lesions in women (and children) Patients usually complain or soreness and dyspareunia, or itch , all of which can be very distressing In children the majority of cases are pre-pubertal and patients are often asymptomatic, although some patients will complain of itch, discharge, dysuria, or constipation Early signs can include pallor and oedema Lesions may be localised or much more extensive affecting the vulva and surrounding skin, the perineum, and around the anus
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