PSD02 A rare presentation of scrotal lichen sclerosus

Abstract

Male genital lichen sclerosus (MGLSc) predominantly affects the glans penis and prepuce. There is increasing evidence that an important factor in the aetiology is chronic exposure of the glans penis to urine under occlusion (usually under the foreskin but often under a lax ‘pseudo-foreskin’ in the circumcised male). Scrotal involvement in lichen sclerosus is extremely rare and sparsely documented in the literature. We report a case of scrotal lichen sclerosus. A 74-year-old circumcised man presented with a 9-month history of penile pruritus and soreness and urinary spraying. Examination showed white sclerotic skin of the glans extending down the penile shaft, consistent with chronic MGLSc. The urinary meatus was dilated. A 3-month reducing course of clobetasol ointment resulted in complete resolution of symptoms. He re-presented 12 months later following a further flare of symptoms. He now reported significant urinary dribbling necessitating the daily use of urinary incontinence pads. A buried penis and new extensive scrotal changes consistent with MGLSc were now evident. Further topical treatment was given and he was referred to urology for assessment. This case highlights an uncommon distribution of MGLSc with scrotal involvement. Chronic moisture, urine exposure and altered anatomy (such as buried penis) may contribute to extension of MGLSc beyond typical sites. Understanding these contributing factors is important in recognizing and preventing complications. Scrotal lichen sclerosus, albeit rarely present as an isolated condition, may occur alongside penile lichen sclerosus. Clinicians should consider this diagnosis when risk factors such as urinary dribbling, incontinence and altered anatomy are present, and consider referral to urology to assess urethral pathology and urinary dribbling. Lower-abdominal weight loss for buried penis is important. We describe a rare case of scrotal lichen sclerosus. This case gives further evidence that chronic urinary dribbling is the most important factor in MGLSc.