Lichen sclerosus/ balanitis xerotica obliterans (BXO)




A chronic, inflammatory skin disease of unknown cause, commonly appearing as whitish patches on the genitals, which can affect any body part of any person but has a strong preference for the genitals (penis, vulva).



It his  known as balanitis xerotica obliterans (BXO) when it affects the penis. 


It is not contagious process. 


There is a well-documented increase of skin cancer risk in BXO.


BXO in adults is normally incurable, but improvable with treatment.


It often gets progressively worse.


It can occur without symptoms. 


White patches on the involved body area, itching, pain, pain during sex, in genital LS, easier bruising, cracking, tearing and peeling, and hyperkeratosis are common symptoms in both men and women. 


In women, the condition most commonly occurs on the vulva and around the anus with ivory-white elevations that may be flat and glistening.


In males, the disease may take the form of whitish patches on the foreskin and its narrowing, known as preputial stenosis, forms an indurated ring. which can make retraction more difficult or impossible-phimosis.


Additional lesions can result in white patches or reddening on the glans. 


Anal involvement is less frequent in males.


Meatal stenosis, making difficult or even impossible to urinate, may also occur.


On  non-genital skin, the disease may manifest as white spots with small visible plugs inside the orifices of hair follicles or sweat glands on the surface. 


On  non-genital skin thinning of the skin may also occur.


The discomfort and pain lead to concerns with self-esteem and sex. 


Suicide is a common form of death as a result of LS/BXO.


RISK factors have been proposed: autoimmune diseases, infections and genetic predisposition.


May be associated with thyroid disease.


Higher rates reported among twins and family members.


Associated with a higher prevalence of autoimmune diseases such as diabetes mellitus type 1, vitiligo, alopecia areata, and thyroid disease.


Both bacterial as well as viral pathogens have been implicated in the etiology o BXO.


LS in females is primarily found in women with a low estrogen state.


LS can be initiated through scarring or radiation, although these findings are  sporadic, and  very uncommon.


The disease often goes undiagnosed for several years.


A biopsy of the affected area can be done to confirm diagnosis. 


Biopsy shows: hyperkeratosis, atrophic epidermis, sclerosis of dermis and lymphocyte activity in dermis.


The biopsies are also checked for signs of dysplasia.


Clinical diagnosis is usually easily apparent.


Differential diagnosis:


lichen planus, localized scleroderma, leukoplakia, vitiligo, and the cutaneous rash of Lyme disease.


There is no definitive cure for LS.


Behavior change is part of treatment. 


Scratching, stress or damage to the skin can worsen the disease. 


Scratching has been theorized to increase cancer risks.


Avoiding tight clothing is recommended,   as it is a major factor in the severity of symptoms in some cases.


Topically applied corticosteroids to the affected skin is the first-line treatment.


Corticosteroids are  are effective when appropriately applied, even over long courses of treatment, rarely causing serious adverse effects.


Topical calcineurin inhibitors such as tacrolimus can have an effect similar to corticosteroids.


Continuous usage of appropriate doses of topical corticosteroids is required to ensure symptoms stay relieved over the patient’s life time. 


If continuously used, corticosteroids may minimize the risk of cancer as seen in various studies. 


Continuous, abundant usage of emollients topically applied to the LS-affected skin is recommended to improve symptoms. 


Appropriate lubrication should be used every time before and during sex in genital LS in order to avoid pain and worsening the disease.


In males, it has been reported that circumcision can have positive effects, but does not necessarily prevent against further flares of the disease and does not protect against the possibility of cancer.


Carbon dioxide laser treatment is safe, effective and improves symptoms over a long time.


Laser treatment does not lower cancer risks.


Platelet rich plasma is reported to be effective 


The process  can last for a considerably long time, but spontaneous remission may ensue, particularly in young girls.


Lichen sclerosus is associated with a higher risk of cancer.


Women with lichen sclerosus may develop vulvar carcinoma.


Lichen sclerosus is associated with 3–7% of all cases of vulvar squamous cell carcinoma.


In women, it has been reported that 33.6 times higher vulvar cancer risk is associated with LS.


The  incidence of penile carcinoma in patients with BXO is 2.6–5.8%.


There is a bimodal age distribution in the incidence of LS in women: occurs in females with an average age of diagnosis of 7.6 years in girls and 60 years old in women. 


The average age of diagnosis of BXO boys is 9–11 years old.


In men, the most common age of BXO incidence is 21-30 years.









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