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Pruritus ani is a common condition with multiple causes. Primary causes are thought to be fecal soiling or food irritants. Secondary causes include malignancy, infections including sexually transmitted diseases, benign anorectal diseases, systemic diseases, and inflammatory conditions. A broad differential diagnosis must be considered. A reassessment of the diagnosis is required if symptoms or findings are not responsive to therapy. The pathophysiology of itching, an overview of primary and secondary causes, and various treatment options are reviewed., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: A rare case of acute urinary retention caused by labial fusion in an adolescent is described and the possible causes are discussed., Case: A 17-year-old girl, not sexually active, presented to our emergency service for acute urinary retention. Genital examination revealed labia minora fusion from the clitoris to the vaginal fourchette; urethra, and clitoris were not visualized. Sexual abuse and trauma were excluded. The labia minora were manually separated in the operating room revealing a normal vagina and urethral meatus. Skin biopsies taken from the fused labia minora revealed Lichen Sclerosus et Atrophicus., Summary and Conclusion: Urinary retention may be seen in the face of complete adhesion of the labia minora, a rare event in postpubertal individuals. In such cases, a suspicion of underlying pathology such as asymptomatic Lichen Sclerosus should be raised and be confirmed by a biopsy., (Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Background: Although penile cancer is rare in developed countries, it occurs more frequently in other parts of the world and causes significant morbidity and mortality., Objective: To review the current literature on the pathogenesis, risk factors, clinical presentation, staging, and treatment of premalignant and malignant tumors of the penis., Materials and Methods: A literature review using PubMed was conducted searching for articles on penile malignancies., Results: The majority of penile cancers are in situ or invasive squamous cell carcinomas, although other rare tumors of the penis occur, such as melanoma, basal cell carcinoma, extramammary Paget's disease, and soft tissue sarcomas., Conclusion: Physicians should be aware of the risk factors and clinical presentation of penile malignancies because early diagnosis is essential in effective management and cure. Accurate staging is imperative for risk stratification and treatment planning. Depending on the type of tumor, size of tumor, location, staging, and grading, treatment modalities vary and may include topical chemotherapy, surgical excision, Mohs micrographic surgery, laser excision or ablation, systemic chemotherapy, and radiotherapy., (© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Background: Lichen sclerosus (LS) is a chronic inflammatory skin disease. Earlier studies have shown an impaired health-related quality of life (HRQoL), but more extensive research including generic questionnaires has not been reported., Objectives: To investigate, in a cross-sectional study, the HRQoL of a sample of Dutch women with LS; to compare the resulting HRQoL data with that available from other skin diseases and the general Dutch population; to explore factors that may influence the HRQoL., Methods: Female members of the Dutch LS Foundation and Support Group filled out three questionnaires electronically: the Skindex-29, the SF-12 and the EQ-5D visual analogue scale (VAS). We distinguished Skindex-29 scores into groups with 'little' (score 0-24), 'mild' (25-31), 'moderate' (32-43) and 'severe' (44-100) impact on HRQoL. We compared differences using the Mann-Whitney U-test and the Kruskal-Wallis test, and correlations using Spearman's rank correlation coefficient., Results: A total of 262 women with LS were included. The average diagnostic delay was 4·9 (SD 7·1) years. Patients had a mean total Skindex-29 score of 38·4 (0-100, SD 17·2). Domain scores for symptoms, emotions and functioning were 46·8 (SD 19·0), 38·2 (SD 20·2) and 33·6 (SD 19·3), respectively. The SF-12 showed average PCS-12 (physical component) and MCS-12 (mental component) scores of 47·7 and 48·5, respectively. For the Dutch population these scores were 49·3 and 52·3. The mean EQ-5D VAS score was 74·1 (SD 15·4)., Conclusions: There is a considerable delay in diagnosis for female Dutch patients with LS. The Skindex-29 domain scores showed a moderately impaired HRQoL. Women with LS reported a lower generic HRQoL than the average female Dutch population., (© 2012 The Authors. BJD © 2012 British Association of Dermatologists.)

Lichen sclerosus is a relatively common chronic inflammatory skin disease that predominantly affects the anogenital area. Accumulating evidence indicates that lichen sclerosus in women may be associated with other autoimmune disease, whereas this association seems to lack in male patients. We retrospectively evaluated the prevalence of autoimmune diseases and serological parameters indicative for autoimmunity in male and female patients with lichen sclerosus. Of the 532 patients (396 women, 136 men; 500 adults, 32 children; mean age: 49 years; range 1-89 years; female:male ratio 3:1), 452 (85%) had genital and 80 (15%) had extragenital disease. In women, lichen sclerosus was significantly more often associated with at least one autoimmune disease as compared to men (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.9-9.6; p<0.0001). Moreover, female patients with lichen sclerosus had sinificantly more often associated autoimmune thyroid diseases (OR 4.7, 95% CI 1.8-11.9; p<0.0002), antithyroid-antibodies (OR 2.7, 95% CI 1.1-6.5; p=0.023), and elevated autoantibodies (OR 4.1, 95% CI 1.9-9.3; p<0.0001) as compared to male patients. This observation is suggestive for a different pathogenetic background in male and female patients.

Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.

Lichen sclerosus et atrophicus (LSA), also called Lichen sclerosus (LS) is a chronic, benign, depigmenting disease of the skin and mucous membranes, most frequently affecting genital mucosa and skin. Involvement of the oral mucosa without concurrent genital or skin lesions has very rarely been reported in the literature. Here we report on two Chinese women with LSA limited to the dorsum of the tongue, and describe the clinical manifestations and histopathological findings of these two patients.

Purpose of Review: Lichen sclerosus is a chronic skin disease that shows a predilection for the anogenital area and may involve anterior urethra causing stenosis. Surgical options in the management of urethral strictures caused by lichen sclerosus still represent a challenging issue., Recent Findings: Depending on the length and severity of urethral involvement, surgical management of lichen sclerosus urethral strictures can range from a simple meatotomy to a single or complex staged long repair using oral mucosa. Skin grafts or flaps are not recommended because skin could be involved by the disease. Perineal urethrostomy may represent the salvage solution in severe panurethral strictures., Summary: One-stage or staged repairs using oral mucosa grafts are the most recommended procedures for the treatment of lichen sclerosus urethral strictures, but derivative perineal urethrostomy may play an important role in severe situations. Patients require long-term follow-up and extensive counseling that enables them to fully grasp the chronic and progressive nature of the disease and to deal with it.

We report 3 patients with long-standing lichen sclerosus who subsequently developed new onset erosive disease in affected sites. Repeated biopsies were performed which, although not diagnostic, showed some features of bullous pemphigoid for 1 patient and nonspecific findings for the 2 others. Direct immunofluorescence showed the characteristic findings of bullous pemphigoid in the first and pemphigus vulgaris in the others. All 3 patients were treated with immunosuppressive agents, and their condition improved dramatically.

Objective: The purpose of our study was to compare clinical data regarding patients with pruritic lichen sclerosus (LS) at moderate or severe stages using 2 different therapies with a 5-year follow-up., Materials and Methods: The study was approved by the institutional review board and was presented as a retrospective clinical data review of patients with pruritic biopsy diagnosis LS who underwent therapy at our university private practice from 2002 to 2005. We compared the results of a weekly topical application of high-potency steroid (HPS) with a combined HPS and monthly anesthetic/steroid subdermal injection (ASI). Outcomes were timed to achieve pruritus-free status, the number of symptomatic recurrences, and patient satisfaction with therapy., Results: Fifty-four patients were diagnosed with LS between 2002 and 2005. There were 13 patients who had mild-stage, 25 who had moderate-stage, and 16 who had severe-stage LS. Five-year follow-up data on 17 patients with moderate-stage LS and 14 patients with severe-stage LS were obtained. Time to pruritus free was 6 weeks with ASI and 19 weeks with HPS for moderate-stage LS (p = .04) and 9 weeks with ASI and 24 weeks with HPS for severe-stage LS (p = .03). Recurrences were more frequent on HPS for moderate-stage LS (p = .04) but not significant with HPS for severe-stage LS (p = .15). Only ASI was successful at treating patients with recalcitrant pruritus., Conclusions: In our population, patients with symptomatic moderate-stage LS seem to have a more rapid and prolonged response to ASI than to HPS but are less satisfied with the injections.

Lichen sclerosus is a chronic inflammatory skin disorder that belongs to a group of autoimmune connective tissue diseases, localized within the skin and mucous membrane of the anogenital area. In the latter location, the focal atrophy of the mucosa is the most visible sign. Lesions may be accompanied by symptoms such as itching, pain, burning. The disease occurs more often in females. The etiology is not fully understood. Genetic, infectious, hormonal factors and autoimmune mechanisms are taken into consideration. Early diagnosis and appropriate treatment is important to avoid further complications. This review aims to analyze available literature on the treatment of this disease entity

Introduction: Lichen sclerosus (LS) is a chronic skin disorder with a predilection for the anogenital area. The disease is mostly seen in prepubertal and postmenopausal females. The lesions present as sharply demarcated white plaques encircling the vagina and anus. The atrophic form can lead to scarring of the affected area., Material and Methods: Retrospective analysis of hospital records of children (aged 1-18 years) seen at the Department of Dermatology and Allergy Centre in Odense from October 1998 to November 2010 with a definite clinical diagnosis of anogenital LS with/without a confirming biopsy., Results: A total of 35 girls and one boy were diagnosed with anogenital LS. The diagnostic delay was 17 months. Pruritus, dysuria, bleeding and constipation were the dominant complaints, while one patient was asymptomatic. Referral was made by general practitioners, private dermatologists and paediatricians. Sexual abuse was suspected in five cases. Ten patients underwent biopsy confirming LS. Before a definite diagnosis was given, many children were extensively treated with various topical and oral agents. In our outpatient clinic, 30 children were treated with potent/ultra-potent corticosteroids and five patients were treated with calcineurin inhibitors., Conclusion: General practitioners may overlook this disorder despite characteristic clinical features and effective symptomatic treatment. Diagnostic delay is a significant problem for both patient and family, and the lesions may mimic the findings of sexual abuse. Potent corticosteroids are very effective in symptomatic treatment., Funding: not relevant., Trial Registration: not relevant.

Objective: This study aimed to examine differences in symptoms and diagnoses between women 50 years and younger and women older than 50 years who have chronic vulvovaginal complaints., Methods: New patients of the Drexel University Vaginitis Center with chronic vulvovaginal complaints were eligible. Participants underwent a standardized medical evaluation and completed detailed questionnaires. Data were analyzed using the t test, χ test, and the Fisher exact test., Results: Subjects were 469 women aged 18 to 79 years. Subjects 50 years and younger (group A) were more likely to complain of vaginal itching and were less likely to complain of burning, irritation, or soreness (p ≤ .05 for all). Subjects older than 50 years (group B) were more likely to be diagnosed with atrophic vaginitis (p = .000), desquamative inflammatory vaginitis (DIV; p = .001), lichen planus (LP; p = .000), and lichen sclerosus (p = .000). Diagnosis of LS, LP, or DIV was associated with increased likelihood of multiparity and decreased likelihood of a history of systemic estrogen use., Conclusions: Postmenopausal women are more likely than premenopausal women to be diagnosed with DIV, LP, or LS. Both childbirth and estrogen nonuse were associated with the occurrence of these latter 3 conditions.

Lichen sclerosus is a chronic inflammatory disease of unknown origin, which affects mostly women in the fifth and sixth decades of life, but can also occur in men and children. The involvement of the oral mucosa alone or together with other forms of presentation is extremely rare, requiring a differential diagnosis with other diseases of the oral cavity, particularly lichen planus. There are less than 30 cases of lichen sclerosus in the oral mucosa described in the literature and there are no reports on malignant transformation so far. We describe a patient with skin, oral and genital lesions of lichen sclerosus.

We present a small review of lichen sclerosus in women and an update on the newest knowledge, e.g. on calcineurin inhibitors as a choice of treatment. The goal is to put more focus on the disease in Denmark because it is so often diagnosed only with a great delay. We further emphasize the importance of follow-up on these patients, due to the risk of cancer, the great influence of the disease on quality of life and the risk of structural changes in the vulva region.

Lichen sclerosus (LS) is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians, pediatricians, and dermatologists. It affects both sexes with a lower incidence in men than in women. Autoimmune factors, infections, and genetic disposition are implicated in its pathogenesis. The classic clinical picture is of atrophic white plaques in the anogenital region. Pruritus, soreness, difficulty retracting the foreskin, and obstructive urinary symptoms are frequent complaints. Early histological confirmation by biopsy is recommended. The disorder is usually highly responsive to ultrapotent topical steroids. This may help arrest or delay the progressive nature of this disorder. Surgical treatment may be needed in cases of disease progression despite medical therapy. Circumcision is a successful treatment, if LS is limited to the glans and foreskin. In cases of meatal stenosis meatoplasty and in cases of urethral involvement one- or two-stage oral graft urethroplasty is necessary.

Lichen sclerosus is a chronic immuno-mediated skin disease of the genital region in men and women. The treatment may be pharmacological or surgical, the choice depending on the extension of the involved area, the histological pattern and the level of functional disease complained by the patient. If the biopsy is negative for neoplastic degeneration the treatment may be pharmacological only. In our paper, we describe the case of a patient with vulvar disease and labial fusion, burial of the clitoris and severe introital stenosis. In this case, the treatment was surgical.

Paediatric gynaecological problems, especially those involving the vulvar area, are common in childhood. The conditions frequently seen include recurrent bacterial vulvovaginitis, vulvar irritation, labial adhesions and dermatological conditions. The presentation and management of these conditions will be reviewed.

A 70-year-old white housewife presented with a rare presentation of coexistent generalized morphea and lichen sclerosus et atrophicus with unusual clinical aspects. The patient had disseminated erythematous lesions that evolved into indurated large plaques. Hypopigmentation and hyperpigmentation developed later, in addition to ivory, white, and shiny plaques on the trunk (Figure 1). The skin of the arms and legs showed a wavy contour (Figure 2). Various areas were markedly sclerotic and some had edematous papules (Figure 3). Multiple indurated, ivory, white, shiny, large, and hypochromic plaques were seen on the trunk Laboratory examinations showed increased immunoglobulin A and antinuclear antibodies 1:200 speckled. Scl-70, anti-centromere, anti-ribonucleoprotein, and anti-DNA tests were negative. Esophageal manometry and abdominal and pelvic ultrasound findings were all normal. Complete blood cell count, blood profile, and urinalysis were also within normal limits. Skin biopsy of an arm lesion showed an atrophic epidermis with orthokeratotic hyperkeratosis and follicular plugging. A broad area of homogenization and edema was seen in the papillary dermis with dilated capillaries and a perivascular lymphocytic infiltration. There was also collagen sclerosis throughout the reticular dermis, and thickened, homogenized collagen bundles replaced the subcutaneous fat. Vessel walls showed proliferated intima with mucin deposition and sclerosis, as well as multiplied elastic layers. There was edema of the papillary dermis in some areas and incipient deposition of calcium (Figures 4-7).

Purpose: The incidence and demographics of lichen sclerosus range from 1/300 (0.3%) to 1/1,000 individuals (0.1%). We analyzed the incidence of lichen sclerosus in an equal access health care system, hypothesizing that it is more common in older white males., Materials and Methods: We reviewed the Department of Defense electronic medical record, Armed Forces Health Longitudinal Technology Application, to determine the number of unique male patients diagnosed with lichen sclerosus between 2003 and 2009. After removing duplicate visits we determined patient age and race, and the regional distribution and overall incidence of lichen sclerosus., Results: Of the 42,648,923 unique male patients in the electronic medical record in this period 604 were diagnosed with lichen sclerosus (0.0014% or 1.4/100,000 visits). Age distribution was similar in the first 3 decades of life but more than doubled in the fourth through sixth decades with the highest prevalence at ages 61 or older (4.4/100,000 patients diagnosed per 100,000 visits, Pearson chi-square p <0.0001). Race distribution was Asian or Pacific Islander 0.9, black 1.4, other 1.7 and white 2.1 patients diagnosed per 100,000 visits (Pearson chi-square p = 0.003). There was a trend in the regional distribution across the United States, as defined by the Department of Health and Human Services, ranging from 0.3 diagnoses per 100,000 visits in Region 2, New York to 2.2/100,000 in Seattle (Pearson chi-square p <0.0001)., Conclusions: In this equal access health care system the incidence of male lichen sclerosus is 1.4 patients per 100,000 visits. It is more common in white men after the third decade of life. There is an association between region and the diagnosis of lichen sclerosus with the highest incidence in the northwestern United States., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Lichen sclerosus (LS) is a sclerosing skin disease. When it appears in boys, it nearly always affects the penis and usually causes phimosis requiring surgical treatment. The clinical significance of this disease in boys is inadequately recognized., Methods: The etiology, clinical manifestations, diagnosis, and treatment of LS in boys are presented in the light of a review of selected literature. We also present our own experience with this disease in an ambulatory pediatric surgery practice., Results: LS has long been recognized as a disease of the prepubertal male genitalia (in such cases, the condition is also called "balanitis xerotica obliterans"). It is thought to be the main cause of acquired phimosis, and it can also involve the meatus and urethra as it progresses. Its possible association with squamous cell carcinoma of the penis remains unclear. Its etiology is unknown; its pathophysiological mechanism involves T-lymphocyte-mediated inflammation. The treatment of choice is complete circumcision. There is still controversy regarding the conservative treatment of LS with topical steroids., Conclusion: LS is much more common in boys than is generally assumed. Lichen sclerosus should be suspected in any case of acquired phimosis. Treatment with complete circumcision does not necessarily bring about a definitive cure. Further research on the pathogenesis of this disease is needed.

In spite of overwhelming evidence that vulvovaginal symptoms plague up to 46% of menopausal and perimenopausal women, and that there persists a reluctance to seek help among patients, adequate vulval and sexual histories are still woefully rare in general gynaecology clinics. This review aims to present the key points of an effective vulval history and an overview of the accepted current management of vulval disease postmenopause, in order that our patients feel encouraged to present with their problems.

Early lesions of lichen sclerosus et atrophicus (LSA) may present as a mild lichenoid tissue reaction, occasionally together with basilar epidermotropism, mimicking early cutaneous T-cell lymphoma, mycosis fungoides (MF) variant. We report a case of extragenital LSA in which both histological patterns were present in the same clinically homogenous and stable lesion. A 27-year-old man presented with a history of white atrophic plaques on the trunk. A biopsy of an abdominal lesion revealed epidermal thinning, a superficial perivascular lymphoid cell infiltrate with focal epidermotropism, mild nuclear atypia and perinuclear halos. Immunophenotyping showed decreased CD5 and CD7, with a slight predominance of CD8-positive T-lymphocytes. All these changes were suggestive of MF. However, a repeat biopsy 3 months later from the same stable plaque revealed features diagnostic of LSA. LSA mimicking early MF histologically has been reported in genital skin. Conversely, MF may clinically and histopathologically resemble LSA. With gene rearrangement studies, clonal proliferation may not be detected in early MF but has been reported to occur in LSA. Awareness of the histopathologic spectrum of LSA within a stable plaque is important to avoid a potential diagnostic pitfall, and should prompt a repeat biopsy.

There is no common pathology in strictures of the external urinary meatus in men and women. These strictures have to be considered in their complexity and history with influential factors like additional diseases and previous surgical interventions. It is necessary to distinguish a simple situation from extensive findings. Successful therapy depends on the exact evaluation and classification of the stricture.

Background & Methods: Oral lichen sclerosus (LS) has been considered uncommon and involvement of lips extremely rare. We reviewed the clinical and histologic features of 72 cases of LS with oral/genital involvement, seen in our institute from 2002 to 2007., Results: Lichen sclerosus was diagnosed with exclusive genital lesions in 45, exclusive lip involvement in 20, and orogenital involvement in seven cases. Fifteen of 27 histologically confirmed lip LS lesions were considered as early inflammatory or presclerotic, eight were intermediate/progressive, and four as late resolved lesions. Lip LS presented as asymptomatic vitiligoid lesions in 70% and dermal sclerosis was demonstrable in only 44%, which was limited to the papillary layer. This was in contrast with genital LS lesions which were asymptomatic in only 12% and demonstrated both papillary and reticular dermal sclerosis in 69%., Conclusion: Lip LS is far less symptomatic and destructive with limited dermal sclerosis compared with genital LS. Greater awareness and histologic assessment are essential for diagnosis because of the misleading vitiligoid appearance. "Vitiligoid LS" a superficial variant proposed by Borda can be aptly applied to lip LS. Dermatologists need to be aware of this rarely reported manifestation of LS as it adds to the spectrum of oral lichenoid lesions and lichenoid dysplasia, which are suspected to have a malignant potential.

Imiquimod has immune-stimulant properties that can precipitate autoimmune conditions like eczema, psoriasis and lichenoid conditions. We report two cases here where imiquimod induced florid lichen sclerosus in one patient and lichen planus in another. In both patients the condition was so aggressive and unresponsive to steroid treatment that circumcision was necessary.

Lichen sclerosus (LS) is a chronic inflammatory skin disease, which most commonly involves the anogenital region. The etiology of LS is obscure, but genetic susceptibility, autoimmune mechanisms, infective agents like human papillomavirus and spirochaetes, and Koebner phenomenon has been postulated as causative factors. We report our observation in 6 patients (3 males and 3 females) with histologically proven lichen sclerosus that showed relative sparing of the uncovered areas of the genitals, thereby suggesting that the occlusion of the genital skin may be playing a greater role in the causation of LS than is currently thought, in both sexes.

Lichen sclerosus is a chronic inflammatory mucocutaneous disease that is highly bothersome for men and women of all ages. The exact etiology is unknown, although genetic and autoimmune factors, as well as infections, have been implicated in its pathogenesis. First-line treatment is highly potent topical corticosteroid therapy for short periods. Surgery is reserved for cases of phimosis, urethral stenosis, synechiae, and squamous cell carcinoma.

Background: Lichen sclerosus (LS) is a rare, chronic inflammatory skin disease that predominantly affects the anogenital area. A few patients exhibit widespread extragenital disease that may lead to blister formation and superficial erosions. We evaluated the efficacy of pulsed high-dose corticosteroids combined with low-dose methotrexate treatment in patients with refractory generalized LS that had failed to respond to standard topical corticosteroid therapy. Observation Seven patients were included in this retrospective study, all of whom were treated with pulsed high-dose corticosteroids combined with low-dose methotrexate for at least 6 months. The outcome measure was an individual, nonvalidated clinical score. Overall, a significant decrease in the clinical score was observed, from a median score of 8 (range, 5 to 24) before treatment to 2 (range, 1 to 4) after treatment. Adverse effects observed during therapy were moderate and disappeared after the end of treatment. During the follow-up period of at least 3 months (mean, 4.7 [range, 3-8] months), none of the patients experienced a relapse of extragenital LS., Conclusions: Patients with severe extragenital LS benefit from pulsed high-dose corticosteroids combined with low-dose methotrexate therapy. This combination therapy should be considered in generalized disease, especially disease that is refractory to conventional treatment.