Lichen Sclerosus: Review of the Literature and Current Recommendations for Management

Journal of Urology, Volume 178: Pages 2268-2276, December 2007.

Jennifer M. Pugliese, Allan F. Morey and Andrew C. Peterson*,†

From the Department of Surgery, Urology Service, Madigan Army Medical Center, Tacoma, Washington (JMP, ACP) and the Department of Surgery, Urology Service, Brooke Army Medical Center, San Antonio, Texas (AFM)

Purpose: We reviewed the literature regarding the clinical presentation, etiology, natural history, and medical and surgical management of lichen sclerosus in men.

Materials and Methods: We performed a comprehensive search of the literature in PubMed, MEDLINE® and other electronic databases between 1950 and 2006 using the key words lichen sclerosis, balanitis xerotica obliterans and urethral stricture. Our search resulted in 1,268 sources containing the words lichen sclerosus or balanitis xerotica obliterans. We reviewed 68 articles in the peer reviewed journals and 2 chapters on this subject.

Results: Lichen sclerosus is a chronic, lymphocyte mediated skin disease that was first described in 1887. It shows a predilection for the anogenital area in men and women. Much has been discovered regarding the epidemiology, natural history and histological features of this disease process during the last century, including the discovery of a strong association between lichen sclerosus and squamous cell carcinoma. The techniques of medical and surgical management of this disorder are still being elucidated. Biopsy of the initial lesion for definitive diagnosis and long-term followup of affected patients are well established, critical elements in the management of lichen sclerosus.

Conclusions: Lichen sclerosus is a chronic, debilitating condition that may progress to cause significant voiding complications. Biopsy is recommended in all patients suspected of having lichen sclerosus to rule out squamous cell carcinoma. Further research is needed to improve the prevention, understanding and treatment of this challenging condition.

Key Words: lichen sclerosus et atrophicus, balanitis xerotica obliterans, urethral stricture

Submitted for publication January 25, 2007.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Army, Department of Defense or the United States Government.
* Correspondence: Madigan Army Medical Center, Department of Surgery, Urology Service, Tacoma, Washington 98431 (telephone: 253-968-2300; FAX: 253-968-2895).
† Financial and/or other relationship with Pfizer.

Citation:

Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol 2007;178:2268-76. doi:10.1016/j.juro.2007.08.024

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