Preventing the long-term consequences of lichen sclerosus

Abstract

To the Editor: Heymann1Heymann W.R. Juvenile lichen sclerosus: a loss of innocence.J Acad Dermatol. 2020; 82: 301-302Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar makes some useful points in his thoughtful article, commenting on the important article by Morrel et al.2Morrel B. van Eersel R. Burger C.W. et al.The long-term clinical consequences of juvenile lichen sclerosus: a systematic review.J Acad Dermatol. 2020; 82: 469-477Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The physical and psychosexual consequences of urogenital lichen sclerosus can indeed be terrible. Prevention, early diagnosis, and effective treatment are essential to mitigate—ideally, to abrogate altogether—these appalling sequelae. The key to these aspirations has to be, as with all diseases, a clear comprehension of the etiopathogenesis. However, this topic received scant attention from your recent contributors. A compelling argument has been articulated in recent years for the pivotal roles of occlusion of urine due to microincontinence and a dysfunctional foreskin in the causation of male genital lichen sclerosus.3Porter W.M. Bunker C.B. The dysfunctional foreskin.Int J STD AIDS. 2001; 12: 216-220Crossref PubMed Scopus (29) Google Scholar, 4Edmonds E. Hunt S. Hawkins D. Dinneen M. Francis N. Bunker C.B. Clinical parameters in male genital lichen sclerosus: a case series of 329 patients.J Eur Acad Dermatol Venereol. 2012; 26: 730-737Crossref PubMed Scopus (98) Google Scholar, 5Bunker C.B. Shim T.N. Male genital lichen sclerosus.Indian J Dermatol. 2015; 60: 111-117Crossref PubMed Scopus (52) Google Scholar, 6Kravvas G. Shim T. Doiron P. et al.The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients.J Eur Acad Dermatol Venereol. 2018; 32: 91-95Crossref PubMed Scopus (30) Google Scholar It is neither necessary nor appropriate to present all of the evidence here. However, I wish to register my surprise and disappointment that there seems to be no enthusiasm or interest to apply these hard-won insights to the prevention, diagnosis, management, and (most crucially) research of pediatric (and, for that matter, adult female) disease. They offer the promise of obviating for women some of the cruel life-changing sequelae, pointedly highlighted by these recent publications—as has been demonstrably achieved in men with lichen sclerosus.4Edmonds E. Hunt S. Hawkins D. Dinneen M. Francis N. Bunker C.B. Clinical parameters in male genital lichen sclerosus: a case series of 329 patients.J Eur Acad Dermatol Venereol. 2012; 26: 730-737Crossref PubMed Scopus (98) Google Scholar,6Kravvas G. Shim T. Doiron P. et al.The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients.J Eur Acad Dermatol Venereol. 2018; 32: 91-95Crossref PubMed Scopus (30) Google Scholar Juvenile lichen sclerosus: A loss of innocenceJournal of the American Academy of DermatologyVol. 82Issue 2PreviewJuvenile lichen sclerosus (LS) is a difficult disorder—symptomatically, emotionally, diagnostically, and therapeutically. The “common knowledge” that juvenile LS abates by adolescence has proved to be a myth. Vulvar LS has a bimodal distribution occurring in childhood and in postmenopausal women: 5% to 15% of cases of LS occur in prepubertal girls. The average age of LS onset in girls is 4 to 6 years. Differential diagnostic considerations include contact dermatitis, vitiligo, lichen planus, morphea, infections, and child abuse. Full-Text PDF Reply to: “Preventing the long-term consequences of lichen sclerosus”Journal of the American Academy of DermatologyVol. 83Issue 3PreviewTo the Editor: I appreciate Dr Bunker's interest and viewpoint regarding the pathogenesis of lichen sclerosus, based on my commentary1 on the article by Morrel et al2 regarding juvenile vulvar lichen sclerosus. Full-Text PDF