Unwarranted hysterectomy in a case of oro-vaginal-vulvar lichen planus in a young woman: a case report

Abstract

Background Lichen planus is a rare autoimmune disease primarily affecting the skin and mucous membranes of the oral mucosa, vulva, and vagina. Diagnosis is difficult and often delayed as the clinicians do not associate the oral symptoms with the genital symptoms. This has a negative impact on the out-of-pocket expenditure and quality of life of the patients. We report this case, as only anecdotal cases have been reported so far from a developing country such as India. We highlight the unindicated hysterectomy that the patient had undergone because of lack of awareness regarding this condition. Our case report also highlights the importance of the multidisciplinary team approach to optimize outcomes and avoid unnecessary morbidity to such patients. Case presentation We report a North-Indian patient with oro-vaginal-vulvar lichen planus who presented to us with complaints of recurrent vulvovaginal symptoms for the last 5 years. She had been previously treated with multiple courses of antibiotics, antifungals, and topical steroids over the course of 3 years and finally offered laparoscopic-assisted vaginal hysterectomy (LAVH) by a private practitioner but got no relief. She also had complained of oral symptoms in the form of a burning sensation after eating spicy food, but did not seek any treatment for this. After multidisciplinary team discussion, a final diagnosis of oro-vaginal-vulvar lichen planus was made at our institute based on the clinical and histopathological findings. The patient was immediately started on oral prednisolone to which she responded with improvement in her symptoms. Conclusion Lichen planus is a chronic painful condition with significant impact on the quality of life. Women often suffer for several years before an accurate diagnosis is made. Treatment is challenging and needs to be individualized with a multidisciplinary approach to prevent progressive anatomical distortion and associated morbidity.

Comparison of electrophysiology therapy and glucocorticoid therapy in the treatment of 2 subtypes of vulvar epithelial non-neoplastic lesions: a prospective cohort study

“…Due to the disorder of cell energy and substance metabolism caused by the disturbance of microcirculation, the activity of tyrosinase in melanosome is affected, and the true melanin (eumelanin) synthesized by tyrosine, dopa, dopamine, and tyroamine decreases, resulting in the hypopigmentation of the diseased skin. This creates great difficulties in the effective treatment of the 2 types of lichen-like lesions (9,10). The local skin microcirculation of the vulva can be improved, the normal state of relaxation and contraction of the arterioles and venules can gradually be adjusted and restored, the blood can be redistributed, and the blood flow can be accelerated.…”