Dennin Margaret H, Stein Sarah L, Rosenblatt Adena E
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Section of Dermatology, University of Chicago, Chicago, IL, USA.
Pediatr Dermatol. 2018 Mar;35(2):198-201. doi: 10.1111/pde.13399. Epub 2018 Jan 4.
BACKGROUND/OBJECTIVES: Vitiligo and lichen sclerosus are autoimmune disorders characterized by white discoloration, and both frequently affect the anogenital region. Vitiligoid lichen sclerosus refers to a superficial variant of lichen sclerosus in which the lesion appears clinically to be vitiligo based on the predominant presentation of depigmentation and minimal inflammation and sclerosis but histologically is consistent with lichen sclerosus. A limited number of reports have described vitiligoid lichen sclerosus, and from these reports, it appears to primarily affect darker-skinned people.
We retrospectively reviewed the records of 7 girls with darker skin types seen in our pediatric dermatology clinic who presented with a clinical overlap of vitiligo and lichen sclerosus. All had primarily well-demarcated, depigmented patches characteristic of vitiligo, but the lesions were symptomatic (pruritus, pain, bleeding, constipation), a presentation more consistent with lichen sclerosus.
The girls were all treated with high-potency topical steroids, calcineurin inhibitors, or both. The associated symptoms improved or resolved, but most had minimal improvement of the depigmentation.
The girls presented in this series appear to have had vitiligoid lichen sclerosus, given the clinical overlap of lichen sclerosus and vitiligo affecting the anogenital region, particularly given that they did not have depigmented patches elsewhere on their body. Previous cases of vitiligoid lichen sclerosus have been reported in darker skin types, and our findings support this possible predisposition. It is important for clinicians to assess patients presenting with genital depigmentation for overlapping features of vitiligo and lichen sclerosus and determine appropriate management.
背景/目的：白癜风和硬化性苔藓是自身免疫性疾病，其特征为皮肤变白，且二者常累及肛门生殖器区域。白癜风样硬化性苔藓是硬化性苔藓的一种浅表型，基于色素脱失为主、炎症和硬化轻微的主要表现，其皮损在临床上看似白癜风，但组织学上与硬化性苔藓一致。仅有少数报告描述过白癜风样硬化性苔藓，从这些报告来看，它似乎主要影响肤色较深的人群。
我们回顾性分析了在我们儿科皮肤科门诊就诊的7名肤色较深女孩的病历，她们表现出白癜风和硬化性苔藓的临床重叠症状。所有人最初都有边界清晰、白癜风特有的色素脱失斑，但这些皮损有症状（瘙痒、疼痛、出血、便秘），这种表现更符合硬化性苔藓。
这些女孩均接受了强效外用糖皮质激素、钙调神经磷酸酶抑制剂或二者联合治疗。相关症状有所改善或缓解，但大多数人的色素脱失仅有轻微改善。
鉴于硬化性苔藓和白癜风在肛门生殖器区域存在临床重叠，特别是这些女孩身体其他部位没有色素脱失斑，本系列中的女孩似乎患有白癜风样硬化性苔藓。之前已有白癜风样硬化性苔藓病例在肤色较深人群中被报道，我们的研究结果支持这种可能的易感性。临床医生评估生殖器色素脱失患者时，检查白癜风和硬化性苔藓的重叠特征并确定合适的治疗方法很重要。
