Immunohistochemical evaluation of androgen receptors in genital and extragenital lichen sclerosus: Evidence for loss of androgen receptors in lesional epidermis

Background: Reduction of lichen sclerosus has been seen with topical testosterone, and spontaneous resolution has been attributed to increasing androgen levels. Objective: Our purpose was to investigate the role of androgens in lichen sclerosus by studying lesional skin and site-specific normal skin for the presence of androgen receptors. Methods: Immunoperoxidase staining for androgen receptors was performed on lesional tissue from 31 patients and microscopically compared with site-specific normal skin. Results: Androgen receptors were present in normal genital and extragenital skin. Lesional genital and extragenital areas showed decreased staining compared with site-specific controls. Finally, staining was decreased in histologically well-developed lesions compared with early lesions. Conclusion: This study provides evidence for the loss of androgen receptors with disease progression in both genital and extragenital skin affected by lichen sclerosus. These findings support a hormonal pathogenesis of lichen sclerosus and may be significant in the treatment of the disease.