ABSTRACT
Lichen sclerosus (LS) is a distressing, chronic inflammatory disease that affects mostly the anogenital areas. An increased risk of genital cancer is also recognized, especially for vulvar LS. The sites most characteristically involved by vulvar LS are the inter-labial sulci, labia minora and labia majora, clitoris and clitoral hood. The main differential diagnoses of genital LS are lichen planus, vitiligo, lichen simplex chronicus, immunobullous disorders and vulvar or penile intraepithelial neoplasia. The diagnosis of genital LS is generally clinical, but a biopsy may be necessary when the clinical picture is not diagnostic. A dermoscopic picture which combines whitish background, whitish patchy structureless areas and vascular desertification is highly suggestive of genital LS. Gray-brown dots arranged in a peppering pattern may frequently be observed in genital LS, as in other genital inflammatory diseases. Red to purpuric, structureless, well circumscribed dots, globules or blotches, which correspond to blood spots, are common features of genital LS.
