LAUSR

available at http://www.ncbi.nlm.nih.gov/pubmed/29900821 Editorial Comment: One of the few major regrets of my professional career is that we have learned so little about lichen sclerosus. Why do some cases involve the skin predominantly, whereas others progress down the urethra either in continuity or as skip lesions? Which cases progress to malignancy? What is the significance of palpable disease? This article assessed 23 dermatopathologists and genitourinary pathologists to determine their criteria for establishing the diagnosis of lichen sclerosus. The most common features reported were 1) dermal collagen homogenization, 2) loss of the normal epidermal rete pattern and 3) atrophic epidermis. Beyond that, opinions were varied regarding etiology (infectious vs autoimmune) and the issue of whether the urethra may be involved in isolation with concomitant glans changes. The results emphasize that improved treatment of this disorder will only occur in conjunction with an improved pathophysiological understanding of the condition.