Lichen sclerosus as a clinical problem

Lichen sclerosus (LS) is a chronic skin disease, mainly diagnosed among women during the postmenopausal period, localized within the genital area [1–3].
The etiopathogenesis of LS is not fully understood, however it seems that the genetic and autoimmune background may have the strongest influence on its development. The relationship with injuries, hormonal disorders, and chronic irritation of the genitals is also suggested [4–9].
For skin lesions located in the area of the vulva, the most common symptoms experienced by patients are itching, skin burns and pain. From the therapeutic point of view, this usually involves antihistaminic and sedative therapy, as well as topical treatment with corticosteroids.
The clinical picture of LS is characterized by swelling of the vulva, which in the course of the disease becomes indurated and inflamed. Further on, it leads to reduction of skin flexibility, the labia are reduced, and the vaginal opening is narrowed. In addition, fissures may appear within the area of the posterior commissure [10].
Treatment of LS is based on the topical use of the corticosteroids twice a day for up to 4 weeks, followed by 1–2 times per week, as well as topical calcineurin inhibitors, retinoids and topical hormonal medications (ointments containing estrogens and progesterone). Furthermore, phototherapy and photodynamic therapy are also suggested [11–13].
The aim of this study is to present three case reports of women diagnosed with lichen sclerosus and a brief review of contemporary therapeutic approaches.
Case 1: A 70-year-old woman was treated in the Department of Dermatology, Poznan University of Medical Sciences, due to the exacerbation in the course of the limited systemic sclerosis and lichen sclerosus previously confirmed by the skin biopsy. The course of the disease was relatively long as it started 20 years before. The patient was hospitalized several times – last time in February 2014. Initially lesions with porcelain-white spots of inflammation were recorded within the thorax, axilla, groin and vulva (Figures 1 A–C). Within about a month, further lesions developed on the anterior abdominal area with clinical characteristics of hemorrhagic morphological-type blisters. A scattered porcelain-white sclerosis was observed on hospital admission. The patient reported intense itching sensation in skin lesions, general weakness, and constant hands tremor. Procaine penicillin (10 injections of 2.4...


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