Perianal lichen dermatoses: A review of 60 cases.
OBJECTIVE
To determine the diagnostic range of lichen dermatoses of the perianus, their extent, and response to treatment.


METHODS
We reviewed perianal biopsies submitted to a tertiary referral pathology service between January 2010 and July 2014, interpreted as 'lichen' or 'lichenoid'. We collected data on patients' characteristics, referring specialty, extent of lesion and response to treatment.


RESULTS
During the study period, 60 perianal biopsies met our inclusion criteria. The distribution of diagnoses was lichen sclerosus (LS) in 25/60 (42%), lichen simplex chronicus (LSC) in 23/60 (38%), lichen planus (LP) in 10/60 (17%), and a non-specific lichenoid reaction in 2/60 (3%). Eleven of 25 cases of LS (44%) showed superimposed LSC. Of 10 LP cases, nine (90%) were hypertrophic and three of these showed pseudoepitheliomatous hyperplasia; none were erosive LP. Compared with patients in the LS and LSC groups, those with LP were more likely to have a localised lesion. Topical steroids were prescribed in 91% cases with treatment data available, and 98% of treated patients who returned for follow up had improved or their disease was resolved.


CONCLUSIONS
We encountered a spectrum of perianal lichen dermatoses, with LS, LP and LSC all represented. LS biopsied at the perianus is often lichenified. Hypertrophic LP is a common form of LP at the perianus.
Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales.|University of Newcastle, Newcastle, New South Wales.
Tania
T
Day
Solo Private Practice, Newborough, Victoria, Australia.
Tanja Gizela
TG
Bohl
University of Newcastle, Newcastle, New South Wales.|Anatomical Pathology, Pathology North, Hunter New England, Newcastle, New South Wales.
James
J
Scurry
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001707:Biopsy, Needle; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008010:Lichen Planus / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D018459:Lichen Sclerosus et Atrophicus / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D017512:Lichenoid Eruptions / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution
D000305:Adrenal Cortex Hormones
lichen planus; lichen sclerosus; lichen simplex chronicus; perianal; pseudoepitheliomatous hyperplasia