Lichen sclerosus et atrophicus

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**Lichen sclerosus et atrophicus**
*Classifications and external resources*
ICD-10	L90.0
ICD-9	701.0

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Lichen sclerosus et atrophicus (LSA) is an inflammatory skin disease usually on genital area. Also known as lichen sclerosus (LS), but LSA is the name in ICD-10 -code: L90.0. Earlier LSA was diagnosed on men as balanitis xerotica obliterans. Balanitis xerotica obliterans is actually LSA of penis and it has been added as part of LSA by Medline. LSA was first described in the end of nineteenth century by Hallopeau and Darier who taught that it's a variant of lichen planus. (Neill et al 2002)

Its causes are poorly understood, but it is unlikely to have an infectious etiology. Autoimmunity is one possible and probable cause. Gynecologist know that LSA is quite common disease. Previously was thought that LSA isn't as common on men, but LSA is surely easier to diagnose for women who frequently go to gynecologist. LSA is surely quite seldom diagnosed.

Typical lesion is white papules or plagues on vulva and perianal region, on men it might be circular lesion on preputium. Lesions might cause itching or burning feeling. For men LSA causes contracting of preputium and phimosis. Contraction might also shorten frenulum which is ligament underneath penis going from urethral opening to preputium.

Diagnosis needs sometime biopsy because LSA may be difficult to differentiate from condyloma. Histologically there's hyperkeratosis, atrophic epidermis, sclerosis of dermis and lymphocyte activity in dermis.

It's treated with corticosteroids or newer takrolimus. Takrolimus might stop the progress of disease and even heal the scars (oral information from dermatologist, not published). Sometimes surgery is needed especially to treat fimosis.

When it occurs on the vulva, it leads in 1-4 % of cases to vulvar carcinoma. For men it might be a major cause for tight foreskin, phimosis.