Incidence of Lichen Sclerosus in Men: A Systematic Review

OBJECTIVES: To systematically review and study the incidence of lichen sclerosus (LS) an underdiagnosed inflammatory mucocutaneous condition primarily affecting the anogenital areas.

METHODS: We performed a literature search using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase and EBM Reviews for studies published from inception of databases. We conducted this review according to published guidelines and using a prespecified protocol. We included primary studies that evaluated the incidence of LS in men. Relevant citations were assessed for eligibility by two independent reviewers and the findings synthesized.

RESULTS: The database search yielded 273 citations; we included six studies in the review. Four studies from Europe and one study from UK reported the incidence of LS among men with mean age ranging from 9-57 years. The study periods ranged from 1997-2021. Incidence among boys aged 0-5 years ranged from 9-32 per 100,000. The highest incidence was found among men aged 20-25 years (73 per 100,000). Of the two studies from Sweden, one reported a cumulative incidence of 0.97% of LS in men, whereas another study reported the annual incidence of LS as 47.2 per 100,000 persons/year. Two studies from USA (1997-2009) reported that the overall incidence of LS ranged from 1.4-70 per 100,000 men. Highest incidence of LS was reported over the age of 60. The incidence of LS was reportedly higher among the Black and Hispanic patients compared with White men. It was also found that the incidence of LS increased from east (New York: 0.3/100,000) to west (Seattle: 22/100,000) of USA.

CONCLUSIONS: Incidence of LS in men is difficult to ascertain as many patients are asymptomatic, unaware, misdiagnosed, or hesitant to report their condition. We present this review to foster translational research in LS among men and to emphasize the need for increased awareness of this condition.