Diagnosis of vulval inflammatory dermatoses: a pathological study with clinical correlation

Diagnosis of vulval inflammatory disease is difficult. In this study, we reviewed 31 vulval biopsies from 23 patients with clinical follow-up. We devised 2 scoring systems from recent publications to determine whether these could help to distinguish between lichen sclerosus (LS) and lichen planus (LP). We found that scoring systems could help in distinguishing LS from LP but that they were no better than using some select pathologic criteria, and were much more time-consuming. Most cases of LS had characteristic dermal sclerosis. LP cases had a characteristic band-like inflammatory infiltrate and did not always have features such as pointed rete ridges, wedge-shaped hypergranulosis and cytoid bodies as observed in nonvulval sites. Eczema was the third most common dermatosis in the study and had features that could also be observed in LS, such as acanthosis, abnormal collagen, and ectatic blood vessels. However, dermal sclerosus was not observed. Loss of dermal elastin fibers was observed in both LS and LP and thus did not help in discriminating between the 2 conditions. Oral LP elsewhere in the body was common and was observed in 20% of both the LS and LP group. A small proportion of patients did not fit into any category. We believed that it was important not to label patients as having a disease unless specific features were observed. It may be in their best interests to be called nonspecific rather than being put in the wrong disease category.