Lichen sclerosus of the vulva

Lichen sclerosus is a non-neoplastic chronic inflammatory dermatosis that can affect any cutaneous body surface, showing particular predilection for the anogenital area in females. It is clinically characterized by progressive and worsening degeneration of the dermal/epidermal layers, which determines hyperkeratinization, and a thick scar-like appearance of the external genitalia. Very often, atrophic changes of the genital structures - labia majora and minora, clitoris and vulvar vestibule - are evident with architectural alterations of the genitalia that cause significant sexual discomfort. Chronic and severe vulvar itching, especially at night, is the predominant symptom reported by almost all patients. Diagnosis is often delayed by long-term self-administered topical preparations, or by the clinician's unawareness of the disease. Indeed, the condition is often misdiagnosed as an aspecific vulvitis. Postmenopausal women are more frequently affected, but young girls and even children may also suffer from vulvar lichen sclerosus. It is now generally accepted as an autoimmune disorder, although its exact pathogenesis remains unclear and controversial, as does its potential role in the onset of vulvar cancer.