Clinicopathologic Comparison of Genital and Extragenital Lichen Sclerosus et Atrophicus

Oh, Sang Ho; Ryu, Dong Jin; Lee, Kwang Hoon; Lee, Ju Hee

Abstract

BACKGROUND: Lichen sclerosus et atrophicus is a persistent inflammatory dermatosis of unknown etiology with a predilection for the genital area. Although there were many case reports in Korea, there are no studies regarding the clinicopathologic comparison of genital and extragenital lichen sclerosus et atrophicus.
OBJECTIVE
The aim of our study was to evaluate the clinicopathologic characteristics and differences between genital and extragenital lichen sclerosus et atrophicus.
METHODS
Retrospective analysis was performed by reviewing the clinicopatholgic records of 33 patients who were diagnosed with lichen sclerosus et atrophicus from 2000 to 2006 in Yonsei University Severance Hospital.
RESULTS
The most common clinical manifestation is a whitish patch with pruritus on labia minor. The ratio of male to female patients in genital and extragenital lichen sclerosus et atrophicus were 1:10.5 and 1:2.3 respectively. Disease onset ages were 49.9 years and 44.2 years respectively. The most common subjective symptom was pruritus. However, no symptom was more significant in extragenital lichen sclerosus et atrophicus compared to genital lichen sclerosus et atrophicus. Most of the lesions presented as whitish patches and plaques but atrophy, erythema and lichenification could also occur. Histopathologic findings of the extragenital lichen sclerosus et atrophicus showed more significant epidermal thinning and cleft formation compared to genital lichen sclerosus et atrophicus, which suggests that extragenital lichen sclerosus et atrophicus shows more evolved lesions. A few cases of genital lichen sclerosus et atrophicus showed spongiotic dermatitis, lichen simplex chronicus-like and lichen planus-like features in addition to typical pathology, which were suspected as secondary features or early lesions. All the patients were treated with high to mid-potency topical corticosteroid which were effective in both the genital and extragenital lichen sclerosus et atrophicus. There was no cases of squamous cell carcinoma arising in lichen sclerosus et atrophicus during the follow-up.
CONCLUSION
Clinically, there were no symptoms significant to extragenital lichen sclerosus et atrophicus and pathologically extragenital lichen sclerosus et atrophicus showed more significant epidermal thinning and cleft formation. Further research regarding the characteristics and differences between genital and extragenital lichen sclerosus et atrophicus should be performed on larger number of cases.