Lack of oral involvement in a large cohort of women with vulvar lichen sclerosus - a multicenter prospective study

Abstract

Background and objectives: We assessed the prevalence of oral lichen sclerosus in a cohort of women affected with vulvar lichen sclerosus (VLS).

Patients and methods: This prospective, observational study included adult female patients with a histologically proven VLS who attended the Vulva Clinics of three Dermatology Units from January 2020 to July 2023. During this period, all VLS patients were asked to be examined in their oral cavities in order to detect any possible sign of oral diseases, which were then biopsied.

Results: Three hundred women (mean age 64.5 ± 13.0 years) were included, of whom 21 (7%) had a concurrent extragenital LS. In six (2%) patients, white, non-removable lesions were found at oral inspection and biopsied. All cases were histologically lichen planus. No other clinically relevant oral lesions were found. The six women with histologically proven oral lichen planus had more frequent periodontal and autoimmune diseases than the other included subjects.

Conclusions: Our findings confirm the absolute rarity of oral involvement in patients with VLS. They suggest that the oral mucosa, unlike the genitals, is a setting which weakly leads to development of LS, also in predisposed subjects.

Keywords: Vulvar lichen sclerosus; anatomical area; chronic inflammatory diseases; lichen planus; oral lichen sclerosus; pathogenesis.

FIGURE 1

(a) Numerous whitish, flattened papules, some tending towards confluence, on the tongue dorsal surface. (b) Histologic examination showed edema, dense band‐like lymphocytic infiltrate in the papillary and mid chorion, basket‐woven orthokeratosis, hypergranulosis in the epithelium and vacuolar alteration at dermoepidermal junction (hematoxylin‐eosin stain, original magnification x 11).

FIGURE 2

(a) Whitish plaque with linear fissures on the dorsal surface of the tongue and (b) punctate elements with a petechial appearance on the soft palate. (c) Histologic examination from a tongue biopsy revealed a band‐like lymphohistiocytic infiltrate with acanthosis, lymphocytic peribasal exocytosis (hematoxylin‐eosin stain [HE], original magnification x 11) and (d) apoptotic basal keratinocytes (Civatte bodies, in the circle; HE, x 10).