Vulvar Ulcers and Erosions

Bohl, Tanja

doi:10.1097/grf.0000000000000130

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…The leading clinical differential diagnosis for erosive LS is erosive LP and its mimics: graft versus host disease and drug reactions. 10 , 11 All have similar appearance, although erosive LP more often is symmetric or circumferential at the vestibule. Other alternate diagnoses include superinfection, usual VIN, and differentiated VIN; these may be excluded through a combination of microbiology and biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…There are many etiologies of genital ulcers to include pressure, infectious, reactive, granulomatous, immunobullous, and manifestations of systemic autoimmune disease. 10 , 11 If an ulcer occurs in a field of well-controlled LS, a comprehensive history, examination, and investigations may be required to determine the cause and direct therapy. Focal fissures in LS may arise from sexual trauma, infection, estrogen deficiency, and undertreatment.…”

Section: Discussionmentioning

confidence: 99%

“…The leading clinical differential diagnosis for erosive LS is erosive LP and its mimics: graft versus host disease and drug reactions 10,11 . All have similar appearance, although erosive LP more often is symmetric or circumferential at the vestibule.…”

Section: Discussionmentioning

confidence: 99%

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Erosive Lichen Sclerosus—A Clinicopathologic Subtype

Day

Otton

Dennerstein

et al. 2021

J Low Genit Tract Dis

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Objective The aim of the study was to identify whether erosive lichen sclerosus (LS) is a distinct clinicopathologic subtype. Materials and Methods The pathology database was searched for “erosion,” “erosive,” “ulcer,” and “lichen sclerosus.” Inclusion criteria were histopathologic diagnosis of LS and erosion or ulcer overlying a band of hyalinization and/or fibrosis. Exclusions were concurrent neoplasia and insufficient tissue. Histopathologic review documented site, epithelial thickness, adjacent epidermal characteristics, infiltrate, and dermal collagen abnormality. Clinical data included demographics, comorbidities, examination findings, microbiologic results, treatment, and response. Results Ten examples of erosive LS and 15 of ulcerated LS occurred in 24 women with a mean age of 67 years. Ulcerated LS was associated with diabetes and nontreatment at time of biopsy. Clinicians identified red patches in all but 1 case of erosive LS. Ulcerated LS was documented as fissure, ulcer, or white plaque, with 8 (53%) described as lichenified LS with epidermal breaches. Erosive LS favored hairless skin with normal adjacent stratum corneum sloping gently into erosion, whereas most ulcers in LS had an abrupt slope from hair-bearing skin. All cases were treated with topical steroids; 2 patients with erosive LS and 10 with ulcerated LS also had oral antifungals, topical estrogen, antibiotics, and/or lesional excision. Treatment yielded complete resolution in 50%. Conclusions Erosive LS is an unusual clinicopathologic subtype characterized by red patches on hairless skin seen microscopically as eroded epithelium overlying a band of hyalinized or fibrotic collagen. In contrast, ulcerated LS is usually a traumatic secondary effect in an uncontrolled dermatosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Erosive Lichen Sclerosus—A Clinicopathologic Subtype

Day

Otton

Dennerstein

et al. 2021

J Low Genit Tract Dis

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“…The difficulty in making a clinical diagnosis is further complicated by these conditions coexisting. 17,18 Two other cases of cicatricial pemphigoid misdiagnosed as vulval LS have been reported. There was no evidence of LS or LP on clinical or histopathological examination.…”

Section: Discussionmentioning

confidence: 99%

Vulval lichen planus–lichen sclerosus overlap

Howard

Hall

2018

Int J STD AIDS

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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.

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“…In addition to a through history, physical exam and appropriate testing for an underlying infectious etiology, a biopsy can also give information regarding potential noninfectious etiologies such as dermatoses, immunobullous disorders, systemic diseases, and malignancy. 1 Here we present three women with vulvar pain and exam notable for a single vulvar ulcer; with history significant for no associated genitourinary disease, but with multiple comorbidities including morbid obesity. Each had a non-specific biopsy demonstrating a dense neutrophilic infiltrate.…”

Section: Introductionmentioning

confidence: 99%