Lichen sclerosus et atrophicus - Een Diepgaande Gids voor Huidziekten

MANAGEMENT

All people with LS should be managed by a health-care professional experienced (secondary care specialist or general practitioner with specific training) in treating the condition

Commence treatment of LS following a firm clinical diagnosis or with histological confirmation, where necessary

Undertake a full history for all people with LS, including dyspareunia and psychosexual issues. Document urinary symptoms. Perform a detailed examination documenting architectural change at baseline

All people treated for LS should be followed up to assess response to treatment and to advise on long-term control

Offer all females with anogenital LS clobetasol propionate (CP) 0.05% ointment on a regimen for 3 months (once a day for a month, alternative days for a month, twice weekly for a month), combined with a soap substitute and a barrier preparation

Discuss the amount of topical treatment to be used, the site of application, and the safe use of an ultrapotent topical steroid with the patient

Consider referral to a specialist vulvar clinic in all females (including children and young people), with LS not responding to a topical steroid, or if surgical management is being considered

Consider intralesional triamcinolone (1–2 mg) in females with LS with topical steroid-resistant, hyperkeratotic areas after intraepithelial neoplasia or malignancy has been excluded by biopsy

Refer female children and young people with LS to specialized vulvar services (vulvar clinic, pediatric dermatologist, or urologist experienced in managing LS).[13]

Treatment failure

If treatment with topical corticosteroids appears to fail to bring LS under control, then it is important to consider the following:

Diagnosis

Scanning magnification of a typical well-developed lesion of lichen sclerosus from the vulva reveals epidermal atrophy, pallor of the papillary dermis, and a perivascular infiltrate in the reticular dermis (H&E, 40x).

High-power magnification demonstrates the pale-staining, homogenized collagen of the upper dermis that is the characteristic features of lichen sclerosus (H&E, 200x).

Due to the chronicity of inflammation, progression of LS can obliterate the normal anatomic structures due to scarring. The disease can relapse and become a lifelong condition. A prospective case series followed 12 girls with prepubertal LS for 10 years until adolescence. The results showed that 25 percent had complete remission, whereas 75 percent remained symptomatic with clinical signs of the disease as adolescents.22 Even though they were diagnosed early and received treatment, childhood onset LS can still be complicated by distortion of vulvar architecture. Other complications include a five percent lifetime risk of developing squamous cell carcinoma, however, this is usually seen in older adult patients who had longer duration of LS.23 Vulvar melanoma has also been reported in a child with LS.24

Lichen Sclerosus Treatments

Although there's no cure for lichen sclerosus, there are treatments that can help.

If you have it on your genitals, you should get it treated, even if you don't have symptoms. You're more likely to have sex and urinary complications if you don't treat it. Patches on other parts of your body may go away with time.

Your doctor will probably first give you a steroid cream to put on the problem area. This can stop the itching. But it may take longer--a few weeks or months--for the skin to return to a more normal appearance.

You may need to use these creams or ointments for a long period of time to keep the condition from coming back.

You'll need to keep up with your doctor appointments, since long-term use of steroid creams or ointments can make the skin become red or thin and cause stretch marks. The treatment can also cause genital yeast infections.