Notable Differences in Clinical Features and Inflammatory Gene Expression Between Genital Lichen Sclerosus and Lichen Planus

<b>Background/Objectives</b>: Genital lichen sclerosus (LS) and lichen planus genitalis (Lpg) are chronic inflammatory dermatoses with overlapping clinical features but incompletely understood pathogenesis. Current therapies are largely symptomatic. <b>Methods</b>: To clarify underlying mechanisms and identify therapeutic targets, we retrospectively analyzed 174 patients (142 LS and 32 Lpg). Clinical features and comorbidities were compared, and gene expression profiling of 730 inflammation-related genes was performed on lesional tissue from LS and Lpg patients and healthy controls using NanoString technology. Selected findings were validated by immunohistochemistry. <b>Results</b>: LS patients were older and predominantly female and more frequently had metabolic syndrome. On the molecular level, LS showed a generally lower inflammatory gene expression profile than Lpg. Nevertheless, LS was characterized by strong upregulation of CCL27 and MARCO, whereas Lpg displayed enhanced IL-1 pathway activation and increased expression of B-cell-associated markers. <b>Conclusions</b>: These results demonstrate distinct immunological differences between the two conditions and provide further insight into disease-specific pathways.