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An infective aetiology for vulval lichen sclerosus re-addressed
A M Farrell1, P R Millard, K H Schomberg
1Department of Dermatology, Oxford Radcliffe Hospitals, UK.
Abstract:
Although there is evidence to support an autoimmune basis for lichen sclerosus, there have also been some studies which suggest an infective aetiology. These include reports of the presence of spirochaetal forms with Steiner silver stains and purplish coccoid forms with Fite stains. We have repeated these studies on vulval biopsies obtained from 16 patients with vulval lichen sclerosus. Using the Steiner silver method we found no evidence of spirochaetal forms in any of the specimens. With the Fite stain we observed purple-staining coccoid forms within the dermis of 13 of the 16 lichen sclerosus specimens. However, these coccoid forms also stained strongly positive with toluidine blue, suggesting they were mast cell granules rather than micro-organisms. We were therefore unable to demonstrate evidence for an infective aetiology in vulval lichen sclerosus, although this cannot yet be excluded. Further work is also needed to understand the significance of mast cells in lichen sclerosus.
Insights
This study investigated an infective cause for vulval lichen sclerosus. Researchers found no evidence of spirochaetes or bacteria, suggesting mast cells, not infections, may play a role.
Area of Science:
- Dermatology
- Pathology
- Microbiology
Background:
- Vulval lichen sclerosus is a chronic inflammatory skin condition with an uncertain etiology.
- While autoimmune factors are implicated, some studies suggest a potential infectious cause.
- Previous research reported spirochaetal and coccoid forms in biopsies, hinting at microbial involvement.
Purpose of the Study:
- To investigate the potential infective aetiology of vulval lichen sclerosus.
- To re-examine biopsies for microbial evidence using specific staining techniques.
- To clarify the role of microorganisms versus other cellular components in the disease.
Main Methods:
- Vulval biopsies from 16 patients with lichen sclerosus were analyzed.
- Steiner silver stain was used to detect spirochaetal forms.
- Fite stain and toluidine blue stain were employed to identify coccoid forms and mast cells.
Main Results:
- No spirochaetal forms were detected in any specimens using the Steiner silver method.
- Purple-staining coccoid forms were observed in 13 out of 16 biopsies using Fite stain.
- These coccoid forms also stained positive with toluidine blue, indicating they were likely mast cell granules, not microorganisms.
Conclusions:
- The study found no evidence supporting an infective aetiology for vulval lichen sclerosus.
- The observed coccoid forms are likely mast cell granules, suggesting a role for mast cells in the condition.
- Further research is required to fully understand the significance of mast cells in vulval lichen sclerosus and to definitively exclude an infectious component.