Lichen sclerosus (Lichen sclerosus et atrophicus, LS&A)
Posted by dkwinter

See also: Vulvar lesions
A chronic inflammatory condition of the anogenital region that most commonly affects women.
May have an autoimmune pathogenesis.
     Characterized by 
          Anogenital discomfort including 
               Painful defecation
     Procelain-white polygonal macules and patches with an atrophic, "cigarette paper" quality.
     Sclerosus and scarring can lead to obliteration of the labia minora and clitoris and a decrease in the diameter of the introitus.
     The diagnosis can readily be made clinically, however vulvar squamous cell carcinoma occurs more commonly in women with LS&A
          When the diagnosis is in question, punch biopsy of any suspicious lesions should be performed
     High-potency topical steroids
          A class I topical corticosteroid in oitment form should be applied twice daily for four weeks, at which point transition to a less potent topical steroid or topical calcineurin inhibitor for maintenance therapy is appropriate