vulvar lichen simplex chronicus; vulvar squamous cell hyperplasia; hyperplastic vulvar dystrophy

Etiology

• reaction to chronic irritation
• exacerbated by rubbing or scratching
• aggravating factors
  • inability to maintain good hygiene
  • candidiasis
  • diabetes mellitus

Pathology

• thickened lichenified epithelium
• excoriation & fissuring
• hyperkeratosis
• erythema on the labia majora

History

• use of possible irritants
  • incontinence pads
  • cleansing products
• contact with unusual agent

Clinical manifestations

• generalized vaginal irritation
• dysuria may be noted
• discomfort may interfere with social activities & sleep
• pruritus during the day may be minimal
• pain (occasional)
• no vaginal discharge
• thickened white or reddish patches involving
  • labia majora
  • outer aspects of labia minora
  • hood of clitoris

Diagnostic criteria

• diagnosis of exclusion

Laboratory

• punch biopsy confirms diagnosis (several sites may be required)

Differential diagnosis

• lichen sclerosus
• psoriasis
• lichen planus
• eczema
• vulvar neoplasm

Management

• remove offending agent(s)
• treat underlying conditions
• potent topical glucocorticoid
  • ointment preferred over cream
    • strings less
    • tends to remain longer
  • 4-6 week course

More general terms

• lichen simplex chronicus (LSC)
• vulvar dystrophy (vulvar disorder)
• sqaumous cell hyperplasia