Awareness of sclerosing atrophic moss Sclerosing atrophic moss is a chronic atrophic lesion of the skin whose cause is not yet known. In Chinese medicine, the disease is thought to be caused by imbalance of yin and yang, disharmony of qi and blood, and external exposure to wind and dampness. Currently, there is a trend of increasing clinical cases. Pathogenesis The etiology is unknown. Because the disease mostly occurs in women aged 40 to 50 years old, it also occurs in young girls, but it can be cured naturally at puberty, suggesting that it may be related to endocrine dysfunction. There are also patients who have vaginitis, circumcision or rash after a new circumcision, indicating that it may be related to infection. Some patients have autoimmune diseases or autoantibodies, HLA-B21 and B40 are more common, suggesting a possible autoimmune cause. There are also reports of familial onset. The pathogenesis is unclear and may be related to endocrine dysfunction, infection, autoimmune disease, or the presence of autoantibodies, or family history. Symptoms and signs: Both men and women can develop the disease, with a predilection for women and a male-to-female ratio of 1:10. Early skin lesions often have no conscious symptoms and are not noticed. The initial damage is a lentil-sized flat-topped papule, round or irregular, pink, with a distinct red edge, soft texture, later gradually developed into a typical lesion, the papule is porcelain white, ivory, hard texture, can be fused with each other into a plaque, the boundary is clear, the central depression, embedded with black-headed acne-like corns, after removing a small pit-like depression. In the later stage, the central atrophy of the lesions becomes thinner and can be fused into well-defined white patches, and the central white patches can be blistered or blood blistered, and after the herpetic damage subsides, more corn papules can be formed, and the atrophy becomes a slightly depressed scar. The lesions are usually found in the upper part of the trunk, such as the supraclavicular fossa, anterior chest area, axilla, both breasts, umbilicus, forearm and neck, and are more common in the external genitalia, with 50% to 75% occurring in the vulva. If it occurs in the female genitalia, it is mostly found around the labia minora, clitoris and anus, and sometimes it can extend to the inner femur, and it can occur singly in the female genitalia, or there can be lesions elsewhere at the same time. Sometimes there is flushing, maceration, vesicles, small blisters, and even bleeding. In the late stage, atrophy and white spots may occur, and the atrophy area expands, which may narrow the urethral opening, and some may be transformed into squamous carcinoma. Itching is obvious at the damage area, and there may be pain, difficulty in sexual intercourse, difficulty in urination and constipation. In men, the vulva is usually seen in old age, and most of them suffer from prepuce or glansitis, and the damage is basically the same as in women. The lesions are usually found on the inner foreskin and glans, and are keratotic papules. They are well-defined, with a pale white surface and may have parchment-like folds. The lesions may also occur on the penis, scrotum and other areas. In severe cases, the lesions may develop into urethral stricture, sclerosis and atrophy of the foreskin tether, or even disappearance of the foreskin, sclerosis of the foreskin that cannot be turned up, or adhesion to the glans due to erosion. Usually itching is not prominent, and cancer is rarely seen. The course of the disease is slow and often lasts for many years. In adults, the damage is mostly progressive, while in children the damage decreases with age. In some cases, the lesions subside on their own at or before the first menstrual period. Treatment 1. General therapy Remove possible triggering factors. Avoid local irritation, treat vaginitis and glansitis, etc.; 2. Internal therapy Give Chinese and Western medicine; 3. Local therapy Give tacrolimus ointment, Centella asiatica cream, etc.; 4. Physical therapy You can use carbon dioxide freezing, 308 excimer laser irradiation. Differential diagnosis: 1. lichen planus; 2. white lesion of female vagina; 3. dropsy sclerosis. Complications In female vagina, atrophy and white spots may occur in the late stage, and the area of atrophy may expand, which may narrow the urethral opening, and some may be transformed into squamous carcinoma. In males, itching is not common, and cancer is rarely seen. Prognosis The course of the disease is slow and often lasts for many years. In adults, the damage is progressive, while in children it decreases with age. In some cases, the lesions fade on their own at or before the first menstrual period.