Lichen sclerosis is a benign, chronic, progressive disease of the skin in which the most common symptom is
a. vulvar pruritis.
b. vaginal discharge.
c. postcoital bleeding.
d. dyspareunia
The correct answer and explanation is:
The correct answer is: a. vulvar pruritis.
Explanation:
Lichen sclerosus (LS) is a chronic inflammatory skin condition that primarily affects the anogenital region, especially the vulva in women. It is considered a benign but progressive disease, meaning it does not cause cancer but can worsen over time if untreated.
- Most common symptom: Vulvar pruritis (itching)
The hallmark symptom of lichen sclerosus is intense, persistent itching (pruritis) of the vulvar skin. This itching can be severe, leading to scratching, which worsens the skin damage and causes discomfort. Patients often describe the itching as worse at night. - Why not vaginal discharge?
Vaginal discharge (option b) is not typically associated with lichen sclerosus. LS affects the vulvar skin but usually spares the vaginal mucosa, which is different tissue and often unaffected. - Why not postcoital bleeding?
Postcoital bleeding (option c) is bleeding after sexual intercourse. While lichen sclerosus can cause fragile skin that tears easily, postcoital bleeding is less common as the primary symptom. It may occur in advanced or severe cases with erosions but is not the most common symptom. - Why not dyspareunia?
Dyspareunia (option d), or painful intercourse, can occur in lichen sclerosus due to scarring, skin tightening, and inflammation that lead to narrowing of the vaginal opening (introital stenosis). However, it is usually a later symptom resulting from disease progression rather than the initial or most common symptom.
Additional Information:
Lichen sclerosus most commonly affects postmenopausal women but can occur at any age, including children. The skin changes include white, shiny, atrophic patches with a parchment-like texture. Over time, scarring can cause architectural changes to the vulva, such as narrowing of the vaginal opening and loss of normal skin folds.
Diagnosis is mainly clinical but can be confirmed by skin biopsy. Treatment typically involves potent topical corticosteroids to reduce inflammation and itching and to prevent disease progression.
In summary, the most common and earliest symptom prompting patients to seek medical advice is intense vulvar itching (pruritis), making option a the correct choice.