Department of Pathology, St. John's Medical College, Bangalore, India.
Department of Dermatology, St. John's Medical College and Hospital, Bangalore, India.
J Low Genit Tract Dis. 2024 Apr 1;28(2):189-197. doi: 10.1097/LGT.0000000000000789.
Lichen planus (LP) and lichen sclerosus (LS) are the most common vulvar lichenoid dermatoses. The diagnostic challenges are due to site-specific variation in microscopic appearance and small-sized biopsies. Authentication of diagnostic criteria to distinguish LS and LP to uncover any resemblance or divergence in presentation of these conditions is attempted.
Cases of vulvar LP and LS diagnosed between January 2012 to December 2022 were included. The clinical details included age, presenting symptoms, examination findings, and other organ involvement. Histopathological analysis of epidermal, dermal, and adnexal findings was done.
There were 28 cases of vulvar LP and 72 cases of LS, with a median age of 51 and 60 years, respectively. Depigmentation and atrophy were the major clinical features in LS, whereas ulcers/erosions and erythema were more prevalent in LP with a significantly higher incidence of oral involvement. The most diagnostic feature in LS was diffuse dermal sclerosis (76.8%) and interstitial pattern of inflammation (81.4%), whereas the characteristic features in LP cases was a lichenoid pattern of inflammation (85.7%), necrotic keratinocytes, and lymphocytic exocytosis. In 44.4% of LS, unconventional features like compact orthokeratosis, parakeratosis, thickened/wedge-shaped hypergranulosis, and sawtooth rete pegs were noted. Lichen sclerosus with lichenoid inflammation (21.4%) mimicked LP, from which it was distinguished by presence of thickened or diminished granular layer with basal melanin absence (60%) and dermal homogenization (80%).
Although the classical, well-established variant of LS poses no diagnostic difficulty, the unconventional variant may mimic LP. Identification of the subtle histological clues demonstrated in this study can help to arrive at the correct diagnosis.
扁平苔藓（LP）和硬化性苔藓（LS）是最常见的外阴苔藓样皮肤病。由于显微镜下外观和小活检的部位特异性变化，诊断具有挑战性。本研究试图验证鉴别 LS 和 LP 的诊断标准，以揭示这些疾病的表现是否存在任何相似或差异。
纳入 2012 年 1 月至 2022 年 12 月期间诊断的外阴 LP 和 LS 病例。临床详细信息包括年龄、主要症状、检查结果和其他器官受累情况。对表皮、真皮和附属器的组织病理学分析。
共 28 例外阴 LP 和 72 例 LS，中位年龄分别为 51 岁和 60 岁。色素减退和萎缩是 LS 的主要临床特征，而溃疡/糜烂和红斑在 LP 中更为常见，口腔受累的发生率显著更高。LS 的最具诊断特征是弥漫性真皮硬化（76.8%）和炎症的间质模式（81.4%），而 LP 病例的特征性特征是苔藓样炎症模式（85.7%）、坏死角质形成细胞和淋巴细胞外渗。在 44.4%的 LS 中，观察到非典型特征，如致密正角化、不全角化、增厚/楔形过度角化和锯齿状网嵴。具有苔藓样炎症的硬化性苔藓（21.4%）模仿 LP，可通过存在增厚或变薄的颗粒层伴基底黑素缺失（60%）和真皮均匀化（80%）来区分。
虽然经典的、确立的 LS 变体没有诊断困难，但非典型变体可能模仿 LP。识别本研究中显示的细微组织学线索有助于得出正确的诊断。
