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Scleroatrophic lichen

 
, medical expert
Last reviewed: 04.07.2025
 
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Lichen sclerosus (synonyms: guttate scleroderma, white spot disease, white lichen of Zumbusch).

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Causes of lichen sclerosus

The causes and pathogenesis of lichen sclerosus are not fully understood. Pathologies of the nervous, endocrine and immune systems, infectious agents, etc. play an important role in the development of the disease.

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Histopathology

In the epidermis, at the early stages of the disease, thickening, hyperkeratosis, horny plugs in the mouths of hair follicles are noted, in the late stages - atrophy. The dermis is edematous, lymphocytic infiltration is observed, capillaries are dilated, collagen fibers are homogeneous.

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Symptoms of lichen sclerosus

Lichen sclerosus is more common in women. The rash is mostly localized on the neck, upper chest, axillary fossa, shoulders, genitals, sometimes on the back, abdomen, thighs. The primary element is a papule the size of a lentil or 3-5 mm in diameter, the color from chalky, similar to old ivory, to whitish-gray with a pearly tint. At the onset of the disease, the clinical picture resembles white spots. Sometimes a thin pink border is noted around the papule. Closely located papules merge into plaques, slightly elevated above the level of the surrounding skin. Later, they give the impression of being somewhat sunken. The clinical picture is like a miniature of plaque scleroderma. Sometimes telangiectasias, petechiae, and blisters are present on the surface of the plaques. In follicular location, hair follicles are enlarged, there is a large number of follicular horny plugs of a brownish-dirty color, somewhat reminiscent of comedones. Localization of scleroatrophic lichen in the vulva is called vulvar kraurosis, and on the foreskin and head of the penis - penile kraurosis. In this case, the lesion is characterized by dryness, sclerosis. In women, the entrance to the vagina narrows, unbearable itching is noted. In men, there are no subjective sensations. Narrowing of the foreskin leads to phimosis. Over time, skin atrophy occurs, pigmentation of the skin of the lesion is noted.

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Diagnosis of lichen sclerosus

Lichen sclerosus should be distinguished from limited scleroderma, discoid lupus erythematosus, diaper rash, and candidiasis.

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Treatment of lichen sclerosus

Scleroatrophic lichen is treated with the use of general strengthening antimalarial drugs (delagyl, resorquine), corticosteroid ointments (corticosteroids are not prescribed in the atrophy stage), and agents that improve blood circulation and tissue turnover.

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