March 2018

  • Patient Information
    • 60 year old female presented with a white, atrophic plaque on her vulva.
  • Clinical Diagnosis
    • Lichen sclerosus
    • Morphea
  • Histology

    Sections show a band of homogenized, sclerotic collagen underlying an atrophic epidermis.

    A lymphocytic infiltrate is present below the band of homogenized collagen.

     

  • Final Diagnosis

    Lichen sclerosus

    • Lichen sclerosus is a chronic inflammatory dermatosis with a predilection for the anogenital region
      • Approximately 20% of patient have extragenital involvement
    • The disease primarily affects middle-aged and elderly woman who are perimenopausal
      • Cases in prepubertal children rarely occur
    • LS presents as white to ivory plaques with follicular plugging and atrophy leading to a wrinkled scar-like appearance
    • Patients may present with pruritus, pain, dysuria or dyspareunia
    • Established lesions of LS are characterized by a homogenized band of collagen below a thinned epidermis with follicular plugging and an associated lymphocytic infiltrate with areas of vacuolar alteration
      • Scattered necrotic keratinocytes are often present
      • Early lesions can have a brisk, band-like infiltrate mimicking lichen planus
      • Vulvar lesions may show acanthosis and changes corresponding to secondary lichenification
    • Lichen sclerosus is associated with an increased risk of squamous cell carcinoma, and malignant transformation does occur in approximately 5% of patients with vulvar lichen sclerosus
  • Summary
    • Lichen sclerosus is a chronic inflammatory dermatosis that often presents with pruritus and has a predilection for the anogenital region
    • The disease primarily affects middle-aged and elderly woman who are perimenopausal
    • LS presents as white to ivory plaques with follicular plugging and atrophy leading to a wrinkled scar-like appearance
    • Established lesions of LS are characterized by a homogenized band of collagen below a thinned epidermis with follicular plugging and an associated lymphocytic infiltrate with areas of vacuolar alteration
    • Lichen sclerosus is associated with an increased risk of squamous cell carcinoma, and malignant transformation does occur in approximately 5% of patients with vulvar lichen sclerosus