Lichen Sclerosus et Atrophicus

Lesions that resembled fungi on the abdomen of a 50-year-old woman had persisted for a year despite treatment with over-the-counter selenium sulfide and antifungal creams. She had no associated symptoms. Jonathan S. Crane, DO, Ronald P. Benjamin, MD, Carla DiBenedetto, PA-C, Patricia Hood, PA-C, and Kelly Mulligan, PA, of Wilmington, NC, suspected that the white, atrophic, “cigarette paper–like” areas on the patient’s abdomen were lichen sclerosus et atrophicus. Results of a 4-mm punch biopsy confirmed the diagnosis. Lichen sclerosus et atrophicus can develop at any age and may affect either sex and persons of all ethnicities. This condition is usually asymptomatic but may cause pruritus. The most common areas of distribution are the trunk, neck, genitals, and oral mucosa. Lichen sclerosus is commonly misdiagnosed as other depigmentation disorders, such as tinea versicolor, morphea, and vitiligo. Consider performing a biopsy to rule out cancer. In patients who have lichen sclerosus of the genital area, a biopsy is required to exclude Bowen disease.1 Topical corticosteroids are effective in treating lichen sclerosus et atrophicus; testosterone 2% ointment and topical tretinoin also may be useful.2  This patient applied fluocinonide ointment twice daily for 3 weeks followed by tacrolimus 0.1% ointment twice daily for 4 months. At 2-month follow-up, the lesions had not increased in size and were much less noticeable. REFERENCES: 1. Odom RB, James WD, Berger TG. Andrews’ Diseases of the Skin: Clinical Dermatology. 9th ed. Philadelphia: WB Saunders Co; 2000:280-283. 2. Fitzpatrick TB, Johnson R, Wolff K, Suurmond D. Color Atlas & Synopsis of Clinical Dermatology: Common & Serious Diseases. 4th ed. New York: McGraw- Hill; 2001:128.