Lichen Sclerosus

Disease History

For many years, the disease known as lichen sclerosus (LS) was reported in urological literature as BXO (balanitis xerotica obliterans). In 1995, the American Academy of Dermatology recommended the use of the term lichen sclerosus.

Lichen sclerosus is a skin disease characterised by chronic inflammation and as been described in men of all ages. Lichen sclerosus can affect any skin area, but in most cases, it is found in the genital area. It is more frequently found in women than in men. The cause is not known. The exact prevalence and incidence of lichen sclerosus is unknown. In 1971, the incidence of lichen sclerosus was estimated to vary from 1 in 300 to 1 in 1,000 patients, as observed by a dermatology department. One study of 1,178 children affected by phimosis demostrated that in 40% of cases, lichen sclerosus was present with a higher incidence in subjects between nine and eleven years of age.

Symptoms

Lichen sclerosus causes obstructive scars that can create problems with urination and sexuality, altering the patient's quality of life. The most frequent symptoms are itchiness, pain, difficulty retracting the foreskin and a weak urinary stream. Clinical tests reveal white types of plaque with leopard spots affecting the glans, the foreskin appearing phemotic, and the incidence of meatal stenosis.

Lichen Sclerosus and Urethral Stricture

Whether or not the urethra is affected in patients with lichen sclerosus of the genitalia is still a matter of controversy. Dermatological literature does not report any information about affects on the urethra in patients with lichen sclerosus. On the contrary, urological literature already began reporting this problem in 1970. In 1999, Barbagli and his colleagues documented the presence of lichen sclerosus in 29% of patients from a series of 106 patients subjected to anterior urethroplasty. Of these, the meatus was affected in 19%, the navicular fossa in 16%, the penile urethra in 3% and the entire anterior urethra in 52% of cases. A high incidence of lichen sclerosus was reported in patients who underwent surgery for hypospadias. However, the correlation between lichen sclerosus and anterior urethral stricture is still under debate, and further studies are necessary.

lichen sclerosus

Causation

The causation of lichen sclerosus remains unknown, but various hypotheses have been suggested:

  • Autoimmune or genetic disorders
  • Infection
  • Hormonal disorders
  • Local irritating factors

 

Treatment

When treating lichen sclerosus, the goals are: alleviate symptoms, prevent cancerous lesions, and solve urinary and sexual problems. Medical treatment of lichen sclerosus includes steroids, hormones and systemic therapy. Surgical treatment of lichen sclerosus includes circumcision, meatoplasty and urethral reconstruction.

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