Autoimmune Disease Prevalence in Females With Vulval Lichen Sclerosus and Screening Patterns in a Multidisciplinary...

Vulval lichen sclerosus (LS) is a chronic inflammatory dermatosis with recognised associations with autoimmune disease, including thyroid disease, vitiligo, and psoriasis. Current expert consensus guidelines recommend investigating for autoimmune disease when clinically indicated by symptoms or signs. More recently, focused screening for thyroid disease and pernicious anaemia in women with LS has been proposed. This study aimed to assess the prevalence of autoimmune disease in a tertiary multidisciplinary vulval clinic and to determine whether findings from this cohort provide support for these proposed screening recommendations.

A retrospective review of electronic medical records was conducted for patients attending a tertiary women's hospital vulval dermatology service between August 2020 and June 2025 with a diagnosis of LS. Data extracted included autoimmune history, serological testing for autoimmune disease (including thyroid function and pernicious anaemia), and family history. Descriptive statistics were used for analysis.

Eight hundred fifty-one patients met inclusion criteria. Autoimmune disease was recorded in 31.7%, with autoimmune thyroid disease (12.5%), lichen planus (8.23%), and psoriasis (5.05%) being most common. Inflammatory arthritis was present in 4.8% and autoimmune dermatological conditions in 18.4%. Serological screening was performed infrequently; thyroid stimulating hormone was performed in 18.4% of patients without known thyroid disease and 6.5% of these were abnormal. Vitamin B12 screening was performed in 8.9% and 10.5% were abnormal. Pernicious anaemia antibodies were performed in 0.35% and all were negative.

This single-centre cohort study demonstrated a high prevalence of autoimmune disease in women with LS, particularly thyroid disease, providing support for consideration of thyroid stimulating hormone screening. Serological testing for autoimmune disease was infrequently documented in this cohort, and the limited data on pernicious anaemia were insufficient to evaluate the proposed recommendation. The findings also highlight a high burden of autoimmune arthritis and other dermatological conditions, suggesting a role for clinical assessment in these domains. Prospective multicentre studies are required to inform and refine screening recommendations.