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Forming diagnostic criteria for vulvar lichen planus
Michelle Wu1, Geoffrey Lee1,2, Gayle Fischer1,2
1Northern Clinical School, University of Sydney, Camperdown, NSW, Australia.
The Australasian Journal of Dermatology
|July 17, 2020
Summary
A new clinical tool aids in diagnosing vulvar lichen planus (VLP) by identifying key symptoms like erosions and pain. This diagnostic aid achieves high accuracy, even when histopathology results are inconclusive.
Area of Science:
- Dermatology
- Gynecology
- Pathology
Background:
- Vulvar lichen planus (VLP) diagnosis is often delayed due to variable clinical presentation and inconsistent histopathology.
- Accurate and timely diagnosis of VLP is crucial for effective management and patient well-being.
Purpose of the Study:
- To develop a clinical diagnostic tool for vulvar lichen planus.
- To correlate clinical diagnostic criteria with histopathology findings for VLP.
Main Methods:
- Retrospective chart review of patients from January 2010 to December 2019.
- Comparison of clinical features between VLP, vulvar lichen sclerosus, and chronic vulvovaginal candidiasis.
- Multivariate nonlinear regression analysis to formulate a score-based diagnostic criteria, tested on patients with inconclusive biopsies.
Main Results:
- Key differentiating clinical features include erosions, glazed erythema, oral involvement, pain/burning, and hyperkeratotic border.
- A score of ≥2 demonstrated 100% sensitivity for VLP, with 92% specificity against vulvar lichen sclerosus and 88% against candidiasis.
- High sensitivity (93-97%) was observed when applying the criteria to patients with normal, non-specific, or suggestive histopathology.
Conclusions:
- The proposed clinical criteria can assist clinicians in diagnosing VLP, particularly when histopathology is inconclusive.
- For patients with ≥2 clinical features, non-specific or suggestive biopsy findings are comparable to conclusive VLP diagnosis.
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