Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, UK.
Br J Dermatol. 2013 Aug;169(2):337-43. doi: 10.1111/bjd.12334.
There is no defined set of criteria for diagnosing erosive lichen planus affecting the vulva (ELPV) and there is geographical variation in management.
To reach consensus on clinicopathological diagnostic criteria for ELPV.
This was a three-stage international electronic-Delphi exercise with a subsequent formal feedback process. In the first two rounds participants were asked to rate the importance of a list of clinicopathological criteria. Responses from round 1 were summarized and presented in round 2, along with additional criteria suggested by participants. In round 3, participants were asked to rate the items that had reached consensus as 'essential' or 'supportive' features in diagnosing ELPV. Consensus was defined as being reached if 75% of participants agreed on the importance of an item.
A total of 73 experts representing dermatology, gynaecology, histopathology and genitourinary medicine participated; 69 (95%) completed all three rounds. Consensus was achieved for the following 'supportive' diagnostic criteria: (i) well-demarcated erosions/erythematous areas at the vaginal introitus; (ii) presence of a hyperkeratotic border to lesions and/or Wickham striae in surrounding skin; (iii) symptoms of pain/burning; (iv) scarring/loss of normal architecture; (v) presence of vaginal inflammation; (vi) involvement of other mucosal surfaces; (vii) presence of a well-defined inflammatory band involving the dermoepidermo junction; (viii) presence of an inflammatory band consisting predominantly of lymphocytes; and (ix) signs of basal layer degeneration. It was suggested that at least three supportive features should be present to make a diagnosis of ELPV, although this number is subject to further discussion.
This study has identified a diagnostic dataset for ELPV that can be adopted into clinical practice and clinical trials.
目前尚无明确的诊断外阴糜烂性扁平苔藓（ELPV）的标准，且管理方法存在地域差异。
就 ELPV 的临床病理诊断标准达成共识。
这是一项分三个阶段进行的国际电子德尔菲研究，随后进行了正式的反馈过程。在前两轮中，参与者被要求对一系列临床病理标准的重要性进行评分。第一轮的回复在第二轮中进行了总结和展示，同时还增加了参与者提出的其他标准。在第三轮中，参与者被要求对已达成共识的项目进行评分，将其评为诊断 ELPV 的“必备”或“支持性”特征。如果 75%的参与者同意某一项目的重要性，则达成共识。
共有 73 名代表皮肤科、妇科、组织病理学和泌尿学的专家参与了研究；其中 69 名（95%）完成了所有三轮。以下“支持性”诊断标准达成共识：（i）阴道入口处有界限清楚的糜烂/红斑区；（ii）病变处有过度角化边界和/或威克姆纹，周围皮肤有威克姆纹；（iii）疼痛/烧灼感症状；（iv）瘢痕/正常结构缺失；（v）存在阴道炎症；（vi）累及其他黏膜表面；（vii）存在累及真皮表皮交界处的明确炎症带；（viii）存在主要由淋巴细胞组成的炎症带；和（ix）基底细胞层变性的迹象。建议至少有三个支持性特征存在才能诊断 ELPV，但具体数量还有待进一步讨论。
本研究确定了 ELPV 的诊断数据集，可用于临床实践和临床试验。
