Medical and Surgical Management of Genital Lichen Sclerosus

Purpose of Review: Lichen sclerosus (LS) is a chronic inflammatory skin condition that can cause debilitating sexual and urinary sequelae in men and women. In this review, we discuss the etiology, clinical presentation, and management options for genital LS. Recent Findings: While medical and surgical management of LS has remained similar for quite some time, techniques such as the Kulkarni urethroplasty have made one stage reconstruction for panurethral LS strictures more feasible. Perineal urethrostomy has become an increasingly preferred treatment modality for complex LS patients. Current LS research has focused on the pathophysiology of the LS at the protein level and possible targets for treatment. Summary: While exact etiology of LS remains unknown, many theories have been hypothesized. The mainstay of medical treatment includes topical steroids. Various reconstructive techniques may be used depending on patient symptoms, extent of involvement, and the location of disease. Non-genital skin grafts, such as buccal mucosa, are recommended in LS patients requiring grafting for urethral reconstruction. Genital skin flaps are not recommended, as they have a high failure rate in this setting. Long-term follow-up is recommended, as LS can be associated with the development of squamous cell carcinoma.