Hypertrophic lichen planus of the vulva - A missed diagnosis

Abstract

Lichen planus (LP) is an inflammatory dermatosis which can affect the skin, nails, and all mucous membranes, including the genitalia. Lichen planus on vulvar keratinized skin can manifest with diverse clinical features, probably due to higher temperature, PH, humidity, and bacterial flora which may modify typical cutaneous features. While lichen planus (LP) may affect the vulva in isolation, it may also be part of generalized outbreak in up to 20% cases. Herein, a case of a 53 year-old female who presented with a severely pruritic plaque over labia majora Since 6 -7 months, with no response to potent topical corticosteroids is reported. Provisional diagnosis of lichen simplex chronicus was considered however, histopathology was suggestive of hypertrophic lichen planus.

Keywords: Hypertrophic; lichen planus; vulva.

Figure 1

Right labia majora showing large hyperpigmented plaque with multiple dilated follicular openings

Figure 2

(a) (×10) Epidermis shows follicular plugging with Wedge- shaped hypergranulosis and basal cell degeneration. Dense band- like infiltrate visible at dermoepidermal junction. (b) (×40) Highlighted area from Figure 2a shows pigment incontinence and presence of melanophages in the dermis