Lichen Sclerosus — SAQ

Stem

A 62-year-old postmenopausal woman presents with a 3-year history of intractable vulvar pruritus, burning, and progressive dyspareunia. On examination, there are ivory-white, atrophic, parchment-like plaques with a "cigarette paper" wrinkled surface on the labia minora, the perineum, and the perianal skin in a "figure-of-eight" distribution. Scattered purpuric/ecchymotic macules are visible within the white plaques. The labia minora are partially resorbed, the clitoris is buried, and the vaginal introitus is narrowed. A 4-mm punch biopsy shows epidermal atrophy, a homogenised eosinophilic band in the papillary dermis, and a band-like lymphocytic infiltrate below the sclerosis.

Questions

a) What is the most likely diagnosis, and what clinical features support it? (2 marks)

b) Describe the histological features of this condition, and explain the significance of the "red-white-blue" zonation. (2 marks)

c) Outline the first-line treatment for this patient, including drug, dose, formulation, frequency, and the rationale for the tapering regimen. (3 marks)

d) What are the long-term complications of this condition, and what surveillance strategy should be instituted? (3 marks)