Lichen sclerosus et atrophicus and autoimmunity in 250 women

Whilst the aetiology and pathogenesis of lichen sclerosus et atrophicus (LSA) remain unknown, it has been established that patients with LSA have an increased incidence of autoantibodies (Goolamali et al., 1974) and autoimmune related disorders (Harrington & Dunsmore, 1981; Meyrick Thomas, Ridley & Black, 1983, 1984). As only a proportion of patients with LSA exhibit such a tendency to autoimmune related phenomena, we have sought to determine whether there are any differences in the natural history of LSA in patients having autoantibodies or autoimmune related diseases (personally or in a first degreee relative) compared with those without such features. We have studied 250 women with histologically confirmed LSA. Fifty‐two (208%) had a personal history of one or more autoimmune related diseases (vitiligo, alopecia areata, pernicious anaemia, insulin‐dependent diabetes mellitus, thyroid disease, bullous pemphigoid); 55 (22%) gave a family history of such autoimmune related disorders; and 109 (436%) had one or more autoantibody in a titre 1:20 or greater. There was a slightly different distribution of age at onset of LSA in the group of patients with an autoimmune related disorder compared with the patients with no associated conditions, but no significant differences were found between those patients with, and those without, autoimmune related phenomena with regard to duration of LSA, onset of LSA in relation to puberty or menopause, site(s) of involvement with LSA and malignant change in LSA‐involved skin. We conclude that the tendency to develop autoimmune related phenomena does not reflect a difference in the natural history of LSA in such patients.