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Lichen Sclerosus and Lichen Simplex Chronicus

by Carlo Raj, MD
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    00:01 Our topic is lichen sclerosus.

    00:04 We’re still dealing with the vulva.

    00:06 And what happens with lichen sclerosus is that, well, as the name implies, there’s going to be narrowing of the orifice.

    00:15 What’s causing the narrowing? There’s atrophy.

    00:17 There will be fibrosis and scarring of the vulvar skin.

    00:22 Why is that and how is the patient going to present? The skin becomes -- well, if you’re thinking about the vulvar region and you’re thinking about the vestibule, that area normally should be rather secretory and it should be, well, rather moist.

    00:42 However, when there’s atrophy taking place of this area and there’s sclerosis and scarring, now you can imagine that this area becomes pale gray and parchment-like.

    00:55 You’re going to find labia becoming atrophied, and as the name implies, sclerosis means narrowed, and the area that’s being narrowed will be the introitus, lichen sclerosus.

    01:07 Causes considerable discomfort and predisposes to acute infection.

    01:12 Most common after menopause is who your population most likely will be.

    01:18 Remember, after menopause, the supply of estrogen starts dropping.

    01:23 And so therefore, this normal vestibular area or the vulvar skin, which normally remains quite moist, is now becoming incredibly dry or maybe even fibrosed.

    01:36 Not precancerous but can be associated with squamous cell carcinoma.

    01:41 This type of sclerosis usually is not associated with cancer.

    01:46 However, maybe associated with squamous cell carcinoma.

    01:53 If you take a look at the area here, on your left, this image is showing you on the right aspect of the vulvar region, you'll find the skin to be quite parched and dry In addition to that, please take a look at the area of the introitus.

    02:10 And this, you’ll find to be quite narrowed.

    02:13 This patient was approximately 53 years of age, and she had undergone menopause.

    02:20 On the right, you'll find the increased fibrosis.

    02:24 And what the arrows are then pointing to here would be exactly that The fact that there’s going to be increased deposition of collagen, increased infiltration of your fibroblast, all this is then giving you a gross examination as what you’re seeing here on the left with lichen sclerosus.

    02:43 If the previous topic was dealing with lichen sclerosus, now we have a condition called lichen sclerosus chronicus.

    02:51 This is nonspecific.

    02:52 What’s happening here? Well, this is chronic in nature.

    02:57 A couple of important differences between lichen sclerosus chronicus and lichen sclerosus Two different conditions.

    03:05 The thickening of the vulvar skin as you would expect to find with lichen sclerosus as well.

    03:10 However, here, think of your patient who’s rubbing and rubbing and rubbing this area to the point where now it’s undergoing a hyperkeratotic type of change.

    03:23 If you take a look at the histologic examination on your right, you will notice at the very top, you have hyperkeratosis.

    03:32 Next, because of all this rubbing taking place with the patient -- so look for patient who might say, “Hey, doc, I got to dinner and I feel quite uncomfortable at times or I feel quite embarrassed because I find myself itching in my genital region.” There’s going to be thickened epidermis.

    03:52 This is then referred to as being acanthosis and dermal inflammation.

    03:59 Not precancerous but can be associated once again with squamous cell carcinoma.

    04:04 Before you move from this topic, make sure that you’re quite comfortable with two conditions that sound alike, but ultimately, do exhibit different histologic pattern.

    04:16 We have lichen sclerosus and here we have lichen sclerosus chronicus.


    About the Lecture

    The lecture Lichen Sclerosus and Lichen Simplex Chronicus by Carlo Raj, MD is from the course Disorders of Vulva, Vagina and Cervix.


    Included Quiz Questions

    1. Pearly white or gray parchment-like skin around introitus, with symptoms of itching and dyspareunia
    2. Foul smelling greenish vaginal discharge
    3. Small grayish brown warts without other symptoms
    4. Vaginal bleeding after menopause
    5. Excessive itching around vulva and thighs at night, with small burrows in skin seen on physical examination
    1. Contact dermatitis
    2. Bartholin cyst
    3. Vestibular adenitis
    4. Bacterial vaginosis
    5. Primary syphilis
    1. ...Lichen sclerosus.
    2. ...Lichen simplex chronicus.
    3. ...Lichen planus.
    4. ...Acanthosis nigricans.
    5. ...Fibromyoma.

    Author of lecture Lichen Sclerosus and Lichen Simplex Chronicus

     Carlo Raj, MD

    Carlo Raj, MD


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