OSCE — Lichen sclerosus

Brief (to candidate)

You will assess a patient with a presentation consistent with Lichen sclerosus.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Lichen sclerosus (LS) is a chronic inflammatory dermatosis producing atrophy and sclerosis of the skin — predominantly anogenital (vulva, glans penis, perianal). Classically postmenopausal women; less common in men (BXO, usually post-circumcision or uncircumcised) and rare in prepubertal girls. Pathophysiology: autoimmune (Th1/IFN-gamma, anti-BP180/BP230 autoantibodies), oxidative stress, fibroblast dysfunction, microvascular damage, reduced elastin. Clinical: ivory-white atrophic parchment-like plaques with cigarette-paper wrinkling, purpura/ecchymoses (PATHOGNOMONIC), fissures, labial resorption, introital stenosis in females; phimosis and meatal stenosis in males (BXO). Histology: the RED

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]