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Classic and Hypertrophic Vulvar Lichen Planus.
Tania Day1,2, Julie Weigner3, James Scurry1,3
1Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
Vulvar lichen planus (LP) on keratinized skin presents diverse clinicopathologic appearances. Hypertrophic LP shows distinct features compared to classic and nonspecific types, highlighting diagnostic challenges.
Area of Science:
- Dermatopathology
- Gynecologic Dermatology
Background:
- Vulvar lichen planus (LP) encompasses erosive, classic, and hypertrophic subtypes.
- The clinicopathologic features of classic and hypertrophic LP on keratinized vulvar skin are not well-defined.
Purpose of the Study:
- To describe and compare the clinicopathologic characteristics of hypertrophic, classic, and nonspecific lichenoid dermatosis on keratinized vulvar skin.
Main Methods:
- Retrospective review of 63 vulvar skin biopsies diagnosed as LP or lichenoid between 2011-2017.
- Cases were classified as hypertrophic LP, classic LP, or nonspecific lichenoid dermatosis based on histopathologic findings.
- Clinical data and histopathologic features were analyzed and compared between groups using descriptive statistics and Fisher exact test.
Main Results:
- Of 63 cases, 46% were hypertrophic LP, 33% classic LP, and 21% nonspecific lichenoid dermatosis.
- Hypertrophic LP was associated with redness, diffuse appearance, scale crust, and plasma cells, differentiating it from classic and nonspecific LP.
- Nonspecific lichenoid dermatosis shared clinical features with classic LP but often lacked dense lymphocytic infiltrate and exocytosis.
Conclusions:
- Vulvar LP on keratinized skin exhibits varied appearances, posing diagnostic challenges.
- Further investigation is needed to elucidate the natural history of hypertrophic LP and clarify the diagnosis of nonspecific lichenoid cases.
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