Lichen Sclerosus

INTRODUCTION

1.What is Lichen Sclerosus Urethra?
2.Therapy for Lichen Sclerorus

 

1.What is Lichen Sclerosus Urethra?

Lichen Sclerosus is a chronic inflammatory skin disease; the etiology is unknown.

It is similar to other dermatological diseases, such as psoriasis and sclerodermia, which have an auto-immune pathogenesis.

For many years it has been believed to be the consequence of sexual infections; however the discovery of lichen sclerosus also in children excluded this hypothesis.

Lichen sclerosus may involve any skin area but in most cases it affects the genitals.
It is  more frequent in women than in men. Although the true spread of this have increased in the last years.
It is known very little and underestimated because patients are examined by different specialists (dermatologists, gynaecologists, urologists, pediatricians) and, as a consequence, the terminology (leucoplakia, lichen, balanite xerotica obliterans), the diagnostic methods and the therapies can be very different.
Normally gynaecologists and urologists do not carry out a complete skin check up, often dermatologists do not evaluate carefully the genitals and the urethra.
The disease is understimated and not treated properly especially in men, thus leading to particularly severe consequences.

The disease is characterized by progressive hardening and white cicatrisation of the tissues.

The pathology starts in the skin that covers the glans (prepuce) and, through different stages of seriousness it affects the glans, the urethral meatus and the urethra in this order.

 

Stage 1 : the prepuce is involved. [fig. L]
Hitching, burning, small annoying cracks. White ring of the prepuce which doesn’t retract anymore and causes fimosis, thus preventing sexual life.

 

Fig. H 1 Fig. H 2 Fig. H 3 Fig. H 4

 

Stage 2: the glans is involved [fig. L]
Presence of white and red areas on glans, and hardening of the mucosa. The prepuce stichs to the glans and does not slide anymore. Sulcus of the glans disappears.

 

 
Fig. L 1 Fig. L 2  

 

Stage 3 : meatal stenosis [fig. M]
The meatus appears white and tight thus blocking the flow of urine.

 

Fig. M 1 Fig. M 2 Fig. M 3

 

Stage 4 : the urethra is involved [fig. N]
The walls of the urethra harden and the lumen thickens for some centimetres (urethral stricture)

 

Fig. N 1 Fig. N 2 Fig. N 3
Figura N 4 Fig. N 5 Fig. N 6
   
Fig. N 7    

 

Stage 5 glans displasia or penile cancer [fig. P]
Patients soffering from lichen sclerosus develop in 8% of the cases penile cancer. Therefore in case of lichen sclerosus it is important to perform some biopsies and to keep the patient under strect followup.

 

Fig. P 1 Fig. P 2 Fig. P 3
Fig. P 4 Fig. P 5 Fig. P 6
Fig. P 7 Fig. P 8 Fig. P 9

2.Therapy for Lichen Sclerorus

  • Topical cortisonic
  • Surgical treatment
  • circumcision
  • meatal surgery
  • uretroplasties
  • glans lesions resections and resurfacing [fig.Q].

 


Fig. Q 1 Fig. Q 2 Fig. Q 3
Fig. Q 4 Fig. Q 5 Fig. Q 6
 
Fig. Q 7 Fig. Q 8