Tips for diagnosis, treatment of vulvar lichen sclerosis.(GYNECOLOGY)

San Francisco -- If left untreated, lichen sclerosis can lead to scarring, destruction of normal vulvar architecture, and even skin cancer, but if caught early and treated properly, complete remission is possible.

"It's a wonderful disease to treat," said Dr. Erika klemperer, a dermatologist in private practice in Santa Bar-bara, Calif. "You can make these patients better."'

The first step is recognizing when the diagnosis is lichen sclerosis and when it is something else, she said at a meeting sponsored by Skin Disease Education Foundation (SDEF).

Patients will complain of pruritus, but they will avoid scratching because it is too painful, In contrast, vulvar lichen simplex chronicus results in an itch that is pleasurable to scratch.

They also will report dyspareunia, dysuria, and painful bowel movements. And patients will either be prepubertal or postmenopausal. she said.

"You've got to thoroughly look at the vulva to pick up the early sings of disease," Dr. Klemperer said. "You have to be comfortable looking in this area so we can help these women you've got to make sure you spread the lips. And not just pulling the labia apart. You really have to manipulate the folds, lift up the clitoral hood."

If it is lichen sclerosis, pallor and edema can be seen, in addition to well-demarcated pearly white plaques that tend to be symmetric and arranged in a figure eight around the vulva, perineum, and perianal regions. The plaques will have a distinctive texture-either a dull, glazed, waxy texture: a very shiny texture; or a fine, crinkled texture.