Vulvar vitiligo and lichen sclerosus in children: A clinical challenge

Abstract

Vulvar vitiligo (VV) and vulvar lichen sclerosus (VLS) are two acquired inflammatory dermatoses characterized by hypo-or depigmentation of the skin and mucosa. Differential diagnosis can be challenging, and biopsy may be required to promptly recognize VLS and prevent irreversible scarring of the vulva. Additionally, these two conditions can also occur in association. This relationship is not surprising given the presumptive autoimmune pathogenesis of both diseases. The aim of this study was to review the clinical and dermoscopic features of VV and VLS in children and to define how they are associated.

Insights from a joint pediatric dermatology‐gynecology vulvar clinic: A retrospective study

“…15.7% of our patients had vitiligo involving the genital mucosa and an extragenital site; the remaining had only anogenital vitiligo. This is consistent with a previous study in which a minority (3/10) of pediatric patients with vulvar vitiligo also had extragenital vitiligo 17 …”

“…This is consistent with a previous study in which a minority (3/10) of pediatric patients with vulvar vitiligo also had extragenital vitiligo. 17 Approximately 33% of vitiligo patients were previously diagnosed with a different condition, most frequently LS. Typically, vitiligo is asymptomatic, whereas LS presents with symptoms including pruritus, pain, burning, and exam features including purpura, fissures, and erosions.…”

“…Typically, vitiligo is asymptomatic, whereas LS presents with symptoms including pruritus, pain, burning, and exam features including purpura, fissures, and erosions. 17 However, co-existent inflammatory vulvitis and vitiligo can lead to a picture that resembles LS. Vitiligoid LS in darker skin types, which resembles vitiligo clinically but is symptomatic and histologically consistent with LS, 8,18 can cause further diagnostic confusion.…”

“…Approximately 33% of vitiligo patients were previously diagnosed with a different condition, most frequently LS. Typically, vitiligo is asymptomatic, whereas LS presents with symptoms including pruritus, pain, burning, and exam features including purpura, fissures, and erosions 17 . However, co‐existent inflammatory vulvitis and vitiligo can lead to a picture that resembles LS.…”

Reflectance confocal microscopy for non‐invasive diagnosis of childhood‐onset vulvar lichen sclerosus: A retrospective study

“…9 To identify the sensitivity and specificity of RCM, the RCM features differences of VLS and VV are compared and evaluated. 10 Although the lesions of the two dermatosis all presented significant decrease in refractive index of basal cell layer, most VLS cases exhibited hyperkeratosis, epidermal atrophy, absence of dermal papillary ring, blurred epidermis-dermis interface, which were much less frequently seen in the lesions of VV (Figure 1h). Dilated vessels were observed in lesions of both, whereas the extent of inflammatory infiltration was different.…”