# Anogenital Erosive Lichen Sclerosus in a Male With Multiple Autoimmune Conditions

## TL;DR

This paper reports a rare case of treatment-resistant lichen sclerosus in a male with multiple autoimmune disorders, emphasizing the challenges in managing the condition.

## Contribution

The novelty lies in presenting a rare case of LS in an unusual location with a complex autoimmune background.

## Key findings

- Lichen sclerosus occurred in the intergluteal cleft, a rare location for the condition.
- The patient had multiple autoimmune disorders, including porphyria cutanea tarda, discoid lupus, and Sjogren's syndrome.
- Treatment with corticosteroids and topicals failed, highlighting the need for alternative approaches.

## Abstract

Lichen sclerosus (LS) is a chronic inflammatory disorder primarily affecting the anogenital region, with a higher prevalence in females and often linked to autoimmunity. This association is not clearly elucidated in males, with LS commonly presenting in uncircumcised males. The most affected areas include the glans penis, prepuce, and coronal sulcus. In this report, we present an 11-year case of treatment-resistant LS in a male patient with an extensive history of autoimmune disorders, manifesting in the intergluteal cleft as a hypertrophic plaque, a rare location. The patient had a complex autoimmune history, including porphyria cutanea tarda, discoid lupus, and Sjogren's syndrome. Histopathological analysis confirmed a diagnosis of erosive LS. Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted. This case highlights the challenges in managing LS, particularly in uncommon sites and in patients with extensive autoimmune backgrounds. Treatment goals for LS focus on symptom relief, cosmetic improvement, and disease prevention. Although topical corticosteroids are commonly used, systemic options like hydroxychloroquine may be beneficial in resistant cases, although clear guidelines are lacking. Our case underscores the importance of a multidisciplinary approach in addressing LS and its associated autoimmune conditions.