Extragenital Skin Involvement in Vulvar Lichen Sclerosus (VLS)

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition primarily affecting the genital and perianal regions. However, in approximately 15-20% of cases, it extends beyond these areas to involve extragenital skin. This less common presentation can significantly impact patients and is essential for accurate diagnosis and effective management.

Definition and Characteristics of Extragenital Skin

Extragenital skin refers to areas of the body outside the genital and perianal regions. In the context of VLS, extragenital involvement typically presents as white, atrophic patches or plaques. Commonly affected sites include the upper back, breasts, thighs, neck, and arms. These manifestations are histologically similar to genital VLS lesions, characterized by thinning epidermis, sclerosis of the dermis, and inflammation.

Prevalence and Symptoms

Studies estimate that extragenital involvement occurs in 15-20% of VLS cases (Madnani et al., 2023; Spring et al., 2022). While these lesions may be asymptomatic, many patients report itching (pruritus), soreness, or burning sensations, similar to symptoms in the genital area. These symptoms can significantly affect the quality of life, especially when the lesions are widespread or associated with discomfort during daily activities.

Clinical Implications

Recognizing extragenital involvement is critical for comprehensive care. Patients presenting with unexplained itchy or white patches on non-genital skin should prompt clinicians to consider VLS as part of the differential diagnosis. This is particularly important as untreated extragenital lichen sclerosus may progress to scarring or cause considerable discomfort. Biopsy of suspected lesions can confirm the diagnosis.

Management

Management of extragenital VLS typically aligns with treatments for genital involvement. High-potency topical corticosteroids, such as clobetasol propionate, remain the gold standard for reducing inflammation and controlling symptoms. Adjunct therapies, such as moisturizers and antihistamines, may also help alleviate itching. Long-term monitoring is necessary to manage flares and minimize the risk of complications.

Conclusion

Extragenital involvement in VLS underscores the systemic nature of the condition and highlights the need for vigilant clinical assessment. Understanding the manifestations and management strategies for extragenital VLS can improve patient outcomes and quality of life.

References

1. Madnani, N., et al. (2023). Atlas of Vulvovaginal Disease in Darker Skin Types. Frontiers in Medicine.

2. Spring, J., et al. (2022). "Clinical Features and Treatment of Lichen Sclerosus." Archives of Dermatological Research. DOI: link.springer.com.

3. Gutiérrez Ontalvilla, P. (2022). So, I Have Vulvar Lichen Sclerosus. What Do I Do Now? Independently published.