When should I consider referring a patient with lichen sclerosus to a

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Consider referring a patient with lichen sclerosus to a specialist for further management if:

The diagnosis is uncertain or requires confirmation.
Symptoms persist despite appropriate primary care management, including use of potent topical corticosteroids.
There is suspicion of a potentially pre-malignant condition or malignant transformation, such as vulval intraepithelial neoplasia or penile squamous cell carcinoma.
Complications arise that may require surgical intervention, for example phimosis, meatal stenosis, or urethral stricture in male genital lichen sclerosus.
There is a need for specialist monitoring due to the risk of malignant transformation associated with lichen sclerosus.

Referral urgency depends on clinical suspicion; urgent or two-week referrals are indicated if malignancy is suspected.

When should I consider referring a patient with lichen sclerosus to a specialist for further management?