Lichen sclerosus et atrophicus

Synonym:

Balanitis xerotica obliterans

Lichen sclerosus et atrophicus (LS and A) is a disease of unknown etiology typically found on the genitals, but which may occur elsewhere.
Porcelain white macules and papules, often with a fine wrinkled, "cigarette-paper" surface, can be surrounded by a rim of mild inflammation. The white patches and plaques gradually extend peripherally. In later stages the lesions may actually become depressed. Atrophic genital lesions can become eroded.
Oral lesions, which can also ulcerate, clinically can resemble those seen in lichen planus.
Lichen sclerosus et atrophicus of the penis is also known as balanitis xerotica obliterans.

Treatment:

• Intra-lesional corticosteroids may show benefit
• Circumcision is the treatment of choice in LSetA in boys with phimosis
• PDT shown to give symptomatic relief
• laser vaporization with CO2 laser is also a possibility
• Case reports using stanozolol, acutretin, etrectinate, and topical cyclosporine
• Anecdotal reports regarding the usefulness of topical tacrolimus in genital LS&A.

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