Are Lichen Sclerosus and Lichen Planus Related?
Is there any relation between lichen sclerosus and lichen planus? Generally, lichen sclerosus and lichen planus are two distinct skin conditions; however, with mostly similar symptoms, it might be difficult to diagnose one from another. While lichen planus usually involves genitals along with oral mucosa, it is rare to involve oral mucosa in lichen sclerosus cases. Lichen planus is mostly a reddish-purple rash with white streaks; lichen sclerosus is mostly white plaque with parched skin. While lichen planus is extremely rare in children, lichen sclerosus can be found in children too.
It is necessary to differentiate both the conditions and reach a confirmatory diagnosis with the help of a biopsy to prevent uneventful scarring from both these conditions.
What is Lichen Sclerosus?
Lichen sclerosus is a rare chronic skin condition that mostly affects women of post-menopausal age and has a predilection for anogenital area. The female to male ratio is 10:1 and affects adults between the age group of 40 to 60. The disease when found in males is known as balanitis xerotica obliterans. Synonyms of lichen sclerosus include Csillag’s disease (sclerosus), Guttate morphea (sclerosus), Hallopeau I disease, lichen sclerosus et atrophicus, white spot lesions, Von Zambusch disease and Guttate scleroderma (lichen sclerosus type).
The exact cause of lichen sclerosus is still unknown. However, it has been linked to autoimmunity, injury and radiation therapy. Genetic predisposition has also been found that might be triggered by environmental factors. It is neither a sexually transmitted disease nor is it contagious.
It is marked by formation of itchy sclerotic white plaques that most commonly affects genital skin. Non-genital disease occurs on trunk and extremities. In genitals, it mostly affects vulva, vagina or penis and/or perianal area, often having figure of eight configuration in the initial stages. The affected skin becomes shiny, wrinkled (parchment like), inflamed and atrophied. The presence of bluish-white pimples, central depression and purplish patches are common. In severe cases, mild chafing may also lead to bleeding and blistering. Involvement of the genitals makes sexual intercourse, riding bicycle and tight clothing discomforting, and affected individuals usually avoid these activities.
What is Lichen Planus?
Lichen planus is an inflammatory, non-infectious skin rash with mild to severe itching. It is an extremely rare condition affecting about 1% of the total population of the world. It mostly affects middle-aged females. The exact etiology of lichen planus is not clear, but it is thought to be an autoimmune disorder. It is more common in patients with liver disorder especially hepatitis C, B or cirrhosis. It is also related to medication use such as beta blockers, antimalarials, diuretics, phenothiazines, anti-inflammatories along with reaction from amalgam restoration (in oral lichen planus).
Lichen planus can occur at various areas such as extremities including arms and legs, oral mucosa, skin (mostly in the elbows, wrists, ankles, shins, armpits and lower back), genitals and around hair follicles. In rare cases, it may even occur in ear canals, esophagus, eye lids and anus. The onset is sudden and may last several months and disappears on its own within a couple of years. The symptoms vary according to the site of lesion. On skin, the rash is usually shiny, raised, flat-topped papule, red, pink or purple in color and might range from mild itchiness to severe itching mostly at night. It is classic of white streaks known as Wickham’s striae. Oral lichen planus may be present mostly on the inner surface of cheeks, but may also involve gums, tongue and lips. In the mouth, it presents with redness, ulcers, dry mouth, change in taste and symptoms worsen with spicy and crispy foods and tomato products. Oral lichen planus has a higher chance of recurrence.
In genitals, the rash may range from reddish to purplish with the development of Wickham’s striae and may be symptom less without any pain or itching. However, with scarring and erosion, the rash might bleed easily making sexual intercourse painful.
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