Medication-Induced Lichen Sclerosus: A Systematic Review

Background

Lichen sclerosus (LS) is an inflammatory skin disease that predominantly affects the anogenital region, although it can occasionally present in extragenital areas. The precise etiology of LS remains uncertain; however, recent studies suggest that certain medications may contribute to its onset or exacerbate its progression. This systematic review and meta-analysis aims to evaluate the association between specific medications and the development of LS.

Methods

A comprehensive search of multiple databases identified 16 publications that met the inclusion criteria. These studies, primarily comprising case reports and case series, revealed a significant correlation between LS and immune checkpoint inhibitors (ICIs), such as nivolumab and pembrolizumab, as well as hormonal therapies, including anti-androgenic oral contraceptives and aromatase inhibitors.

Results

The findings suggest that these medications may disrupt immune tolerance or hormonal homeostasis, thereby contributing to the pathogenesis of LS. The analysis highlights the challenges in managing medication-induced LS, particularly in patients who cannot discontinue the implicated drug due to underlying conditions such as cancer or chronic illnesses.

Conclusion

Despite offering valuable insights into the potential risks of specific medications, the study's limitations—including reliance on small case studies and data heterogeneity—underscore the need for further research. Larger observational studies and randomized controlled trials are essential to validate these associations and inform targeted prevention and treatment strategies. Clinicians should remain vigilant for signs of LS in patients undergoing treatment with these medications to facilitate early diagnosis and intervention.