Lichen Sclerosis: A New Epidemic?

Main Category: Urology / Nephrology
Article Date: 14 Jun 2008 - 3:00 PDT

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ORLANDO, FL (UroToday.com) - Lichen sclerosis (LS) includes balanitis and xerotica obliterans. There is hyperkeratosis and sclerosis of the dermis with collagen deposition that leads to symptoms of skin irritation. It is much more common in women and also occurs in 10% of boys with phimosis. A larger study of boys more recently showed a 39% incidence with phimosis and circumcision cured almost all patients. In adults undergoing urethroplasty, 14% were found clinically, but in 82% by histology.

Etiology is unclear and may be bacterial, viral, trauma, hormonal changes or an autoimmune problem. A predominance of T cells in the specimens supports an autoimmune origin. 3-6% of women may go on to develop squamous cell carcinoma. Several studies support this link.

The treatment of penile LS includes circumcision, topical steroids, dilation and meatotomy. For urethral involvement reconstruction is often needed. Unobstructed voiding, painless intercourse and acceptable cosmesis are the goals of treatment. Topical steroids such as 0.05% clobetasol propionate are most commonly used. Topical estrogen, progesterone and testosterone have been proposed, but prospective studies do not support their use over steroids. External meatotomy is useful to mange distal urethral obstruction. However, longer strictures are complex to treat and buccal mucosal grafting is often needed. Split thickness skin grafts in addition to buccal mucosa are needed for long strictures.

There are 4 case reports of LS occurring in the mouths of patients who were grafted. Use of perineal urethrostomy is sometimes needed temporarily as well. If the patient is circumcised and has no stricture, topical steroids are prescribed. If not circumcised, that is performed. If a stricture is present, imaging and surgical correction is performed if urethral dilation and topical steroids are not successful. He concluded that LS is often under-diagnosed and good treatment is possible.

Presented by Andrew C. Peterson, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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