Dermatology Clinic mimic an irritant dermatitis; genital squamous cell carcinoma and sexual abuse in children must always be ruled out. LS of the penis can be confused with Bowen disease and balanitis. Although vulvar LS can be diagnosed clinically, skin biopsy is often necessary for diagnosis of extragenital lesions. Histologic examination reveals epidermal atrophy, t hickening of the papillary dermis by altered collagen bundles, and vacuolar interface dermatitis with a lichenoid inflammatory cell infiltrate. First-line treatment of LS involves topical corticosteroids. Generally, a high-potency corticosteroid such as clobetasol 0.05% cream is the therapy of choice. Treatment starts with a once-daily application and tapers down to once- or twiceweekly application. Although topical immunomodulators, such as tacrolimus and pimecrolimus, are often considered, one study6 showed that topical clobetasol was significantly more effective in treating the signs and symptoms of LS.
(approximately 5% or less2) of malignant transformation of genital LS to genital squamous cell carcinoma; therefore, these patients should be carefully educated and examined annually. The patient in our case was educated regarding the condition. She was treated with clobetasol cream, applied once daily for 4 weeks and twice weekly thereafter. At the 3-month follow-up visit, she reported resolution of the itching and her skin appeared moderately, although not completely, improved. As the condition was no longer bothersome, the patient chose to stop treatment and elected to monitor herself for any further progression. n Esther Stern, NP, is a family nurse practitioner at Advanced Dermatology & Skin Surgery, P.C., in Lakewood, N.J. References
First-line treatment of lichen sclerosus involves topical corticosteroids, such as high-potency clobetasol 0.05% cream.
1. Lopez RE, Troutman DL, Hossler EW. Plantar lichen sclerosus et atrophicus. J Am Acad Dermatol. 2013;68(Suppl 1):AB57. 2. James WD, Berger TG, Elston DM. Epidermal nevi, neoplasms, and cysts. In: James WD, Berger TG, Elston DM, eds. Andrews’ Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, PA: Saunders-Elsevier; 2011. 3. Paller AS, Mancini AJ. Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 4th ed. Philadelphia, PA: Elsevier Saunders; 2011. 4. Makaron T, Viscomi B, Matayoshi L, Michalany N, Petri V. Genital lichen sclerosus et atrophicus in childhood treated by tacrolimus. J Am Acad Dermatol. 2009;60(Suppl 1):AB151. 5. Lacarrubba F, Pellacani G, Verzì AE, Pippione M, Micali G. Extragenital lichen sclerosus: clinical, dermoscopic, confocal microscopy, and histologic correlations. J Am Acad Dermatol. 2015;72(1 Suppl):S50-S52. 6. Funaro D, Lovett A, Leroux N, Powell J. A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus. J Am Acad Dermatol. 2014;71:84-91.
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Intralesional corticosteroids should be considered in appropriate cases. Resistant cases may respond to topical tretinoin, oral isotretinoin, or photodynamic therapy. Surgical treatment is reserved for severe cases with scarring. Asymptomatic extragenital cases may not require treatment, as the skin appearance frequently does not improve, even with topical steroid use. In addition, it is important to note that most cases of LS in the pediatric population resolve spontaneously during puberty. Patients using potent topical steroids should be monitored closely for signs of skin atrophy. There is an increased risk