Vulvar lichen planus
- Susan M Cooper, MB ChB, MRCGP, FRCP, MD
Susan M Cooper, MB ChB, MRCGP, FRCP, MD
- Consultant Dermatologist and Honorary Senior Clinical Lecturer
- Oxford University Hospitals
- Stephanie J Arnold, FACD, MBBS (Hons), BSc (Hons)
Stephanie J Arnold, FACD, MBBS (Hons), BSc (Hons)
- Consultant Dermatologist
- Churchill Hospital Department of Dermatology, Oxford
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
Lichen planus is a relatively uncommon inflammatory dermatologic condition with subtypes that can affect the skin, mucosa, nails, and scalp. Vulvar lichen planus is a subtype of lichen planus that is characterized by erosive, papular, or hypertrophic lesions on the vulva, with or without concomitant vaginal involvement.
Erosive lichen planus (also known as mucosal lichen planus) can result in severe tissue destruction that leads to vulvar pain and urinary and sexual impairment. Erosive lichen planus also can affect other mucosal sites, such as the oral cavity, nasal mucosa, esophagus, larynx, conjunctiva, and urethra .
High quality studies to guide treatment of vulvar lichen planus are lacking. Superpotent topical corticosteroids are well accepted as the first-line treatment for erosive disease.
Vulvar lichen planus will be discussed here. Other clinical presentations of lichen planus are reviewed separately. (See "Lichen planus", section on 'Clinical features' and "Oral lichen planus: Pathogenesis, clinical features, and diagnosis".)
Lichen planus is estimated to affect 0.5 to 2 percent of the population; estimates have varied based upon geographic location and diagnostic criteria . The incidence and prevalence of vulvar lichen planus has not been clearly established, but vulvar disease may be a common manifestation of lichen planus in women. In one series of 37 women diagnosed with lichen planus, vulvar lesions were present in 51 percent .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL MANIFESTATIONS
- Erosive lichen planus
- Papulosquamous lichen planus
- Hypertrophic lichen planus
- Lichen planopilaris
- Clinical evaluation
- Proposed diagnostic criteria
- DIFFERENTIAL DIAGNOSIS
- NATURAL HISTORY
- Associated malignancy
- Erosive vulvar lichen planus
- - Adjunctive measures
- - First-line therapy
- Topical corticosteroids
- - Efficacy
- - Administration
- - Second-line therapy
- Topical tacrolimus
- - Efficacy
- - Administration
- - Severe erosive lichen planus
- - Refractory disease
- - Vaginal involvement
- Intravaginal corticosteroids
- Other therapies
- - Adhesions and scarring
- - Emerging therapy
- Treatment of hypertrophic and papulosquamous lichen planus
- Treatment of vulvo-vaginal-gingival syndrome
- Treatment of concurrent infection
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS