Lichen sclerosus is a chronic inflammatory disease of unknown cause that is characterized by white, atrophic plaques with intense pruritus affecting the skin, nails, hair, and/or mucous membranes. It most commonly affects the anogenital area and often occurs in postmenopausal women. Although the condition is benign, it is associated with an increased risk of squamous cell carcinoma. Lichen sclerosus is diagnosed clinically and should be confirmed via punch biopsy in adults, which can concurrently screen for squamous cell carcinoma. Treatment primarily consists of superpotent topical steroids but may also include surgical excision in steroid-refractory disease.
- Prevalence: rare disease (occurs in < 2% of the female population) 
- Sex: most commonly affects (postmenopausal) women
- Mean age of onset: 52 years; less commonly affects prepubertal girls (age 7–8 years) 
Epidemiological data refers to the US, unless otherwise specified.
- Factors such as genetic predisposition, autoimmunity, hormonal changes are thought to play a role. 
Early disease 
- Papules and plaques that are white, polygonal, well-demarcated, and potentially surrounded by a red inflammatory halo
- Dominant symptom: severe pruritus, possibly pain/soreness
- Most commonly affects the anogenital area
- Extragenital lesions: oral and areas of skin (e.g., back, shoulders, neck, wrists, thighs, and under the breast)
- Vaginal infections
- Lichen planus
- Atrophic vaginitis
- Chronic cutaneous lupus erythematosus
- Lichen simplex chronicus
- Pityriasis rosea
- Lichenoid mycosis fungoides
The differential diagnoses listed here are not exhaustive.
- Benign condition
- Increased risk of squamous cell carcinomas, e.g., 
- Destructive scarring (steroids may prevent) 
We list the most important complications. The selection is not exhaustive.