M. Wu1, G. Fischer1,2, G. Lee1,2
Vulval Lichen Planus (vLP) is a chronic inﬂammatory con- dition of the skin and mucosal surfaces affecting women of all ages. It is a rare yet debilitating and painful condition that can dramatically impact a patient’s quality of life. Diagnosis is often signiﬁcantly delayed as its appearance is highly variable. Existing diagnostic guidelines were formu- lated based on expert opinion1; however, validation studies
have shown a poor correlation with histopathology results, with only one in three cases matching2. Thus, this study aimed to formulate an evidence-based diagnostic tool and streamline treatment guidelines for patients with vLP.
Between 2008 and 2019, 243 patients with clinically sus- pected vLP from a single outpatient clinic were prospec- tively recruited. Clinical features were compared between patients with biopsy-proven vulval lichen sclerosus (n = 50) and vulvar lichen planus (n = 96). The features that signiﬁcantly differentiated between them were the presence of erosions (p < 0.001), glazed erythema (p < 0.001), heavy discharge (p < 0.001), oral involvement (p < 0.001), pain/burning sensation (p < 0.001), vaginitis (p < 0.001), vulvar erythema (p < 0.001) and hyperkera- totic border (p < 0.001). By using multivariate regression analyses, we formulated a score-based diagnostic criterion, and found that if a patient had ≥ 3 of the above 8 features, they could be considered to have vLP. Using this scoring method sensitivity was 98.96% and speciﬁcity was 98%. At present, the formulation of a diagnostic criterion with a histopathological basis offers much potential in guiding clinicians in the assessment and management of vLP. References 1. Simpson, R., Thomas, K., Leighton, P. and Murphy, R. (2013). Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise. British Journal of Dermatology, 169(2), pp. 337–343. 2. Cheng, H., Oakley, A., Rowan, D. and Lamont, D. (2015). Diag- nostic criteria in 72 women with erosive vulvovaginal lichen pla- nus. Australasian Journal of Dermatology, 57(4), pp. 284–287.