Lichen Sclerosus et Atrophicus

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Abstract
A comprehensive account of this many-faceted and fascinating disease could be of formidable length. I shall review a few aspects of particular interest, especially those that raise questions as yet unanswered. More detailed discussion and references can be found elsewhere.1,2 ETIOLOGY The article by Shirer and Ray in this issue of the Archives comments on familial incidence; one such recent and striking report3 is of lichen sclerosus et atrophicus (LSA) at the vulva in identical twin girls of HLA types A2/3, B7/60, and C3/7. Although the evidence linking LSA with HLA types is at present somewhat confusing, these findings suggest that there is a significance awaiting elucidation. Strange, too, is the link with autoimmune disease,4-6 and the fact that when the link is present it confers no particular pattern on the clinical manifestations. Apart from the suggestion that some local anomaly of sex-hormone metabolism is involved, some