Vulval lichen planus–lichen sclerosus overlap

Abstract

Vulval lichen planus-lichen sclerosus overlap is an emerging observation. Few clinical reports exist with no reviews of literature. We present a focused update of this phenomenon and discuss a clinical case. We report a 63-year-old woman with a 20-year history of ulcerative vulvo-vaginitis, initially diagnosed as benign mucous membrane (cicatricial) pemphigoid. This led to prolonged treatment with oral corticosteroids with minimal improvement in symptoms. Subsequent complications of long-term use of systemic corticosteroid ensued. A clinico-pathological diagnosis of severe erosive lichen planus was made on clinical findings and on non-specific biopsy changes of ulceration and inflammation. Treatment with topical clobetasol propionate 0.05% ointment twice daily led to dramatic improvement of ulceration, easing of discomfort and marked improvement in quality of life. Clinical examination revealed Wickham's striae on the labia majora supporting the diagnosis. Six years after commencement of topical clobetasol, white plaques were noticed on the labia majora, perineum and peri-anal region consistent with lichen sclerosus, confirmed by repeat vulval skin biopsy and on vulvectomy. This case highlights the challenge of diagnosis of extensive vulvo-vaginal ulceration and the necessity to re-examine a previous diagnosis if there is poor response to treatment.

Retrospective analysis of the clinical characteristics and patient‐reported outcomes in vulval lichen planus: Results from a single‐center study

“…6 Cases of an overlap of VLP and VLS have been described, leading to the discussion of whether VLP and VLS are a continuum, rather than independent entities. 7,8 Patients with VLP should undergo gynecological assessment to exclude vaginal involvement. The major aims of treatment are symptomatic relief and the prevention and/or limitation of scarring.…”

Comorbidity in patients with Lichen sclerosus: a retrospective cohort study

“…However, this study shows that patients with LS have an increased risk for thyrotoxicosis, which is in line with previous studies [ 27 ]. Lichen ruber planus is commonly found coexisting with LS lesions [ 18 ]. The strong association presented in this study supports this.…”

“…The association between LS and thyroid disease has been established in women, but is not clear in men [ 2 ]. Several case reports and smaller studies have found an association between psoriasis [ 16 ], vitiligo [ 17 ], lichen planus [ 18 ], alopecia areata and ulcerative colitis [ 19 , 20 ].…”

Erosive vulvar lichen planus and risk of vulvar neoplasia: retrospective case series review

“…In most cases, the diagnosis was clinical; histology was reserved to the cases refractory to first line treatments and/or when suspicious lesions were observed. Nevertheless, while some authors defend that clinical appearance are nonspecific for vulvar LP and often shared with other dermatosis, like LS, 14,22 among different guidelines the use of histology for the diagnosis of vulvar dermatosis is not consensual. [23][24][25] In the light of these conflicting positions about the diagnostic criteria of vulvar LP and considering that we normally used the clinical criteria for establishing the diagnosis, it could be seen as a limitation of this study.…”