The Journal of Urology
Volume 178, Issue 6 , Pages 2268-2276 , December 2007

Lichen Sclerosus: Review of the Literature and Current Recommendations for Management

  • Jennifer M. Pugliese

      Affiliations

    • Department of Surgery, Urology Service, Madigan Army Medical Center, Tacoma, Washington
    • ,
  • Allen F. Morey

      Affiliations

    • Department of Surgery, Urology Service, Brooke Army Medical Center, San Antonio, Texas
    • ,
  • Andrew C. Peterson

      Affiliations

    • Department of Surgery, Urology Service, Madigan Army Medical Center, Tacoma, Washington
    • Corresponding Author InformationCorrespondence: Madigan Army Medical Center, Department of Surgery, Urology Service, Tacoma, Washington 98431 (telephone: 253-968-2300; FAX: 253-968-2895).
    • Financial interest and/or other relationship with Pfizer.

Received 25 January 2007

References 

  1. Val I, Almeida G. An overview of lichen sclerosus. Clin Obstet Gynecol. 2005;48:808
  2. Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet. 1999;353:1777
  3. Venn SN, Mundy AR. Urethroplasty for balanitis xerotica obliterans. Br J Urol. 1998;81:735
  4. Das S, Tunuguntla HS. Balanitis xerotica obliterans—a review. World J Urol. 2000;18:382
  5. Yesudian PD, Sugunendran H, Bates CM, O’Mahony C. Lichen sclerosus. Int J STD AIDS. 2005;16:465
  6. Wallace HJ. Lichen sclerosus et atrophicus. Trans St Johns Hosp Dermatol Soc. 1971;57:9
  7. Dogliotti M, Bentley-Phillips CB, Schmaman AS. Lichen sclerosus et atrophicus in the Bantu. Br J Dermatol. 1974;91:81
  8. Wang J. Histopathological and ultrastructural studies of lichen sclerosus et atrophicus of the vulva. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 1991;13:327
  9. Kiss A, Kiraly L, Kutasy B, Merksz M. High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study. Pediatr Dermatol. 2005;22:305
  10. Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000;86:459
  11. Laymon CW. Lichen sclerosus et atrophicus and related disorders. AMA Arch Derm Syphilol. 1951;64:620
  12. Bainbridge DR, Whitaker RH, Shepheard BG. Balanitis xerotica obliterans and urinary obstruction. Br J Urol. 1971;43:487
  13. Peterson AC, Palminteri E, Lazzeri M, Guanzoni G, Barbagli G, Webster GD. Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans). Urology. 2004;64:565
  14. Ramrakha-Jones VS, Paul M, McHenry P, Burden AD. Nail dystrophy due to lichen sclerosus?. Clin Exp Dermatol. 2001;26:507
  15. Jensen T, Worsaae N, Melgaard B. Oral lichen sclerosus et atrophicus: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:702
  16. Barbagli G, Palminteri E, Bracka A, CaparrosSariol J. Penile urethral reconstruction: concepts and concerns. Arch Esp Urol. 2003;56:549
  17. Regauer S. Immune dysregulation in lichen sclerosus. Eur J Cell Biol. 2005;84:273
  18. MeyrickThomas RH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus et atrophicus and autoimmunity—a study of 350 women. Br J Dermatol. 1988;118:41
  19. Weide B, Walz T, Garbe C. Is morphoea caused by Borrelia burgdorferi? (A review). Br J Dermatol. 2000;142:636
  20. Drut RM, Gomez MA, Drut R, Lojo MM. Human papillomavirus is present in some cases of childhood penile lichen sclerosus: an in situ hybridization and SP-PCR study. Pediatr Dermatol. 1998;15:85
  21. Beattie PE, Dawe RS, Ferguson J, Ibbotson SH. UVA1 phototherapy for genital lichen sclerosus. Clin Exp Dermatol. 2006;31:343
  22. Neill SM, Lessana-Leibowitch M, Pelisse M, Moyal-Barracco M. Lichen sclerosus, invasive squamous cell carcinoma, and human papillomavirus. Am J Obstet Gynecol. 1990;162:1633
  23. Requena L, Kutzner H, Escalonilla P, Ortiz S, Schaller J, Rohwedder A. Cutaneous reactions at sites of herpes zoster scars: an expanded spectrum. Br J Dermatol. 1998;138:161
  24. Yashar S, Han KF, Haley JC. Lichen sclerosus-lichen planus overlap in a patient with hepatitis C virus infection. Br J Dermatol. 2004;150:168
  25. Kohlberger PD, Joura EA, Bancher D, Gitsch G, Breitenecker G, Kieback DG. Evidence of androgen receptor expression in lichen sclerosus: an immunohistochemical study. J Soc Gynecol Investig. 1998;5:331
  26. Skierlo P, Heise H. Testosterone propionate ointment—a therapeutic trial in lichen sclerosus et atrophicus. Hautarzt. 1987;38:295
  27. Miller RA. The Koebner phenomenon. Int J Dermatol. 1982;21:192
  28. Pock L. Koebner phenomenon in lichen sclerosus et atrophicus. Dermatologica. 1990;181:76
  29. Milligan A, Graham-Brown RA, Burns DA. Lichen sclerosus et atrophicus following sunburn. Clin Exp Dermatol. 1988;13:36
  30. Yates VM, King CM, Dave VK. Lichen sclerosus et atrophicus following radiation therapy. Arch Dermatol. 1985;121:1044
  31. Pass CJ. An unusual variant of lichen sclerosus et atrophicus: delayed appearance in a surgical scar. Cutis. 1984;33:405
  32. Margolis DJ. Cutaneous diseases of the male external genitalia. In:  Retik AB,  Walsh PC,  Vaughan ED,  Wein AJ editor. 8th ed.. Campbell’s Urology. vol 1:Philadelphia: WB Saunders Co; 2002;p. 715–718chapt 19
  33. Powell J, Robson A, Cranston D, Wojnarowska F, Turner R. High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol. 2001;145:85
  34. Leibowitch M, Neill S, Pelisse M, Moyal-Baracco M. The epithelial changes associated with squamous cell carcinoma of the vulva: a review of the clinical, histological and viral findings in 78 women. Br J Obstet Gynaecol. 1990;97:1135
  35. Nasca MR, Innocenzi D, Micali G. Penile cancer among patients with genital lichen sclerosus. J Am Acad Dermatol. 1999;41:911
  36. Cubilla AL, Velazquez EF, Young RH. Pseudohyperplastic squamous cell carcinoma of the penis associated with lichen sclerosus (An extremely well-differentiated, nonverruciform neoplasm that preferentially affects the foreskin and is frequently misdiagnosed: a report of 10 cases of a distinctive clinicopathologic entity). Am J Surg Pathol. 2004;28:895
  37. Kiss A, Csontai A, Pirot L, Nyirady P, Merksz M, Kiraly L. The response of balanitis xerotica obliterans to local steroid application compared with placebo in children. J Urol. 2001;165:219
  38. Bracco GL, Carli P, Sonni L, Maestrini G, DeMarco A, Taddei GL, et al. Clinical and histologic effects of topical treatments of vulval lichen sclerosus (A critical evaluation). J Reprod Med. 1993;38:37
  39. Friedrich EG. Topical testosterone for benign vulvar dystrophy. Obstet Gynecol. 1971;37:677
  40. Sideri M, Origoni M, Spinaci L, Ferrari A. Topical testosterone in the treatment of vulvar lichen sclerosus. Int J Gynaecol Obstet. 1994;46:53
  41. Bousema MT, Romppanen U, Geiger JM, Baudin M, Vaha-Eskeli K, Vartiainen J, et al. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study. J Am Acad Dermatol. 1994;30:225
  42. Basak PY, Basak K. Lichen sclerosus et atrophicus of the scalp: satisfactory response to acitretin. J Eur Acad Dermatol Venereol. 2002;16:183
  43. Parsad D, Saini R. Oral stanozolol in lichen sclerosus et atrophicus. J Am Acad Dermatol. 1998;38:278
  44. Wakelin SH, James MP. Extensive lichen sclerosus et atrophicus with bullae and ulceration—improvement with hydroxychloroquine. Clin Exp Dermatol. 1994;19:332
  45. Penneys NS. Treatment of lichen sclerosus with potassium para-aminobenzoate. J Am Acad Dermatol. 1984;10:1039
  46. Ronger S, Viallard AM, Meunier-Mure F, Chouvet B, Balme B, Thomas L. Oral calcitriol: a new therapeutic agent in cutaneous lichen sclerosis. J Drugs Dermatol. 2003;2:23
  47. Rouzier R, Haddad B, Deyrolle C, Pelisse M, Moyal-Barracco M, Paniel BJ. Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol. 2002;186:49
  48. Morey AF, Lin HC, DeRosa CA, Griffith BC. Fossa navicularis reconstruction: impact of stricture length on outcomes and assessment of extended meatoplasty (first-stage Johanson) maneuver. J Urol. 2007;177:184
  49. Zinman L. Muscular, myocutaneous, and fasciocutaneous flaps in complex urethral reconstruction. Urol Clin North Am. 2002;29:443
  50. Barbagli G. When and how to use buccal mucosa grafts in penile and bulbar urethroplasty. Minerva Urol Nefrol. 2004;56:189
  51. Atala A. Experimental and clinical experience with tissue engineering techniques for urethral reconstruction. Urol Clin North Am. 2002;29:485
  52. McAninch JW. Reconstruction of extensive urethral strictures: circular fasciocutaneous penile flap. J Urol. 1993;149:488
  53. Barbagli G, Palminteri E, DeStefani S, Lazzeri M. Penile urethroplasty: techniques and outcomes using buccal mucosal grafts. Contemp Urol. 2006;18:25
  54. Kastner U, Altmeyer P. Cryosurgery—the last resort or a surgical alternative in the treatment of lichen sclerosus et atrophicus of the vulva (LSAV)?. J Dtsch Dermatol Ges. 2003;1:206
  55. Rosemberg SK, Jacobs H. Continuous wave carbon dioxide treatment of balanitis xerotica obliterans. Urology. 1982;19:539

 The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Army, Department of Defense or the United States Government.

PII: S0022-5347(07)01995-7

doi: 10.1016/j.juro.2007.08.024

The Journal of Urology
Volume 178, Issue 6 , Pages 2268-2276 , December 2007

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