Skin nontumor

Lichenoid and interface reaction patterns

Lichen sclerosus et atrophicus

Last author update: 1 August 2011
Last staff update: 5 September 2023 (update in progress)

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PubMed Search: Lichen sclerosus et atrophicus [title]

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M. Lichen sclerosus et atrophicus. website. Accessed September 27th, 2023.
  • Atrophic, hypopigmented patches or plaques, usually affecting the upper trunk, neck, flexor wrist or anogenital region
  • Often women near menopause
  • Cause unknown but associated with HLA DQ7 and autoimmune disorders
  • Has been described at areas of scars and at sites of radiotherapy
  • In girls, may start at an early age with hemorrhagic perianal lesions; associated with constipation; may be mistaken for sexual abuse
  • LS may co-exist with lichen planus and morphea or resemble lichen planus (Case Rep Dermatol 2010;2:55)
  • Balanitis xerotica obliterans: involvement of glans penis
  • Kraurosis: vulvar involvement; important complication is dysplasia / squamous cell carcinoma
Clinical features
  • Atrophic, hypopigmented patches or plaques
Microscopic (histologic) description
  • Orthokeratotic hyperkeratosis, epidermal atrophy, hydropic degeneration of basal layer, replacement of papillary dermis by edematous, hypocellular, faintly staining band with chronic inflammatory infiltrate
  • Early lesions may have lichenoid changes
  • Late lesions may have hyalinization
Microscopic (histologic) images

Images hosted on other servers:

Thinned epidermis
with superficial
dermal collagen

Differential diagnosis
  • Localized scleroderma (morphea)
  • Lichen planus: lacks psoriasiform lichenoid pattern, epidermotropism affecting the basal cell layer, basement membrane thickening, foci of epidermal atrophy, and loss of papillary elastic fibers
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