Pathophysiology, Clinical Manifestations, and Treatment of Lichen Sclerosus: A Systematic Review

Urology. 2020 Jan:135:11-19. doi: 10.1016/j.urology.2019.09.034. Epub 2019 Oct 9.


Objective: To elucidate current understanding on the pathophysiological mechanism of genital lichen sclerosus (LS), urologic manifestations, and treatment options.

Materials and methods: The Medline/PubMed and Embase databases were systematically reviewed for publications pertaining to LS. After applying inclusion and exclusion criteria, references were assessed for relevance to the pathophysiology, presentation, and treatment of LS by title and abstract review by 2 independent reviewers, yielding 186 articles for assessment.

Results: The contemporary understanding of the epidemiology and histology of LS is reviewed herein. Additionally, we explore in detail the 3 hypotheses regarding the pathophysiological mechanism contributing to disease presentation: infectious etiology, primary immune dysregulation, and the isotraumatopic response. We summarize the available biological evidence supporting each hypothesis. This discussion provides context for understanding LS morbidity and may spur new avenues of research. For the clinician, we review the clinical presentation of disease, including the risk of progression to squamous cell carcinoma. The current medical and surgical treatment options are also detailed.

Conclusion: LS remains a potentially insidious disease which may lead to debilitating urinary and sexual dysfunction. Cross disciplinary research should aim for earlier detection, as well as more effective and durable treatment. The exact cause of LS remains unknown.

Publication types

  • Systematic Review

MeSH terms

  • Administration, Topical
  • Balanitis Xerotica Obliterans / diagnosis*
  • Balanitis Xerotica Obliterans / epidemiology
  • Balanitis Xerotica Obliterans / therapy
  • Biopsy
  • Circumcision, Male
  • Diagnosis, Differential
  • Disease Progression
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Lichen Sclerosus et Atrophicus / diagnosis*
  • Lichen Sclerosus et Atrophicus / epidemiology
  • Lichen Sclerosus et Atrophicus / therapy
  • Male
  • Penis / pathology
  • Penis / surgery
  • Prevalence
  • Treatment Outcome
  • Vulva / pathology
  • Vulvar Lichen Sclerosus / diagnosis*
  • Vulvar Lichen Sclerosus / drug therapy
  • Vulvar Lichen Sclerosus / epidemiology


  • Glucocorticoids