Lichen sclerosus
It is an autoimmune-based pathology that results in progressive discomfort and sclerosis of the vulvar tissues in females, and of the foreskin and glans in males. It can occur in adulthood, and rarely also in pediatric and adolescent ages.
In most cases, a related pathology is found, such as thyroiditis, connective tissue diseases, inflammatory bowel diseases, diabetes, and chronic inflammations of the genital area. Even in the absence of an autoimmune disease, irregularities in the intestine (constipated or diarrheic stool) are often observed.
The diagnosis
In most cases, the diagnosis is clinical, meaning it is made by an experienced doctor. In some cases, histological examination is necessary because the diagnosis is not straightforward and differential diagnoses with other types of lichen that are not lichen sclerosus come into play. In some cases, histological examination is performed due to suspicion of neoplastic evolution.
Familiarity
Familiarity can be observed but in rare cases. Currently, there is no test that can determine predisposition to the disease.
The progression
Lichen sclerosus is a chronic disease whose progression needs to be monitored and appropriately treated.
Each case has a different progression. Some cases develop slowly, while others progress more rapidly.
Lichen sclerosus and tumor evolution
The evolution of tissues affected by lichen into tumors ranges from 5% to 15%. Such a high percentage mostly refers to untreated individuals or those treated inappropriately, leading inflammation to cell degeneration.
If patients are properly diagnosed and treated, the risk is greatly reduced.
Microscopic tissue changes
Every tissue is composed of a network of collagen and elastic fibers where cells reside. Vascularization is ensured by small vessels that supply the tissues.
In lichen sclerosus, histology highlights tissue changes well.
There is a reduction in vascularization, modification of fibroblasts, which are the cells that produce collagen. The collagen produced is stiff rather than soft as it should be. Elastic fibers decrease significantly.
Inflammatory cells increase, both those that cause chronic inflammation and those that appear in cases of acute inflammation.
The alternating phases of the disease
The clinical history of patients with lichen involves ups and downs. There are times when the disease is completely under control and others when symptoms flare up.
It is important not only to treat the genital region but also to understand what triggered the recurrence of the disease. Sometimes it may be an autoimmune comorbidity such as thyroiditis, other times it may be due to an intestinal issue that has caused severe constipation. The bowel pattern and lichen are often connected.
