Pelisse M
Service de dermatologie et vénérologie, Clinique Tarnier, Paris.
Rev Prat. 1997 Oct 1;47(15):1674-7.
The most common form of vulvar dermatose is the lichen sclerosus. More frequent after menopause, it can be observed at all ages, even in childhood. Vulvar lichen sclerosus manifests usually by a vulvar pruritus and (or) orificial dyspareunia, however in 15% of cases it remains asymptomatical. The lesions can extend to all the vulva, giving it a very particular pearly white aspect, or remain localized as a "leucoplasia", requiring biopsy to confirm the diagnosis. It is mostly the hyperplastic lichen sclerosus (consisting of a marked epithelial hyperplasia) which risks degeneration. In case of non-response to a strong local steroid therapy, high risk clinical cases must be pointed out, treated and biopsied. A biopsy must be done in thick leucoplastic areas which are coarse, steady and rebellious to treatment, specially on ulcered zones without any tendency to healing or palpable infiltrated lesions.
最常见的外阴皮肤病形式是硬化性苔藓。绝经后更为常见，可发生于所有年龄段，甚至儿童期。外阴硬化性苔藓通常表现为外阴瘙痒和（或）性交困难，然而在15%的病例中无症状。病变可累及整个外阴，使其呈现出非常特殊的珍珠白色外观，或局限为“白斑”，需要活检以确诊。最易发生退变的是增生性硬化性苔藓（由明显的上皮增生组成）。如果对强效局部类固醇治疗无反应，必须指出、治疗并活检高危临床病例。对于增厚、粗糙、顽固且对治疗无反应的白斑区域，特别是无愈合倾向的溃疡区或可触及的浸润性病变，必须进行活检。
