Authors: Nicole S. Kim, Medical Student, University of Toronto, Canada; Dr Yuliya Velykoredko, Dermatology Resident, University of Toronto, Canada. DermNet NZ Editor-in-Chief: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. DermNet NZ Editor-in-Chief: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. September 2018.
Lichen simplex of the vulva is a pruritic form of dermatitis in which excessive scratching or rubbing leads to lichenification. Characteristically, there are well-demarcated, erythematous or hyperpigmented, thickened plaques affecting one or both sides of the vulva. Lichen simplex is typically secondary to an underlying skin condition or neuropathy causing a severely itchy vulva.
Lichen simplex is also known as lichen simplex chronicus and neurodermatitis [1,2,5].
Vulvar lichen simplex is most frequently seen in atopic adult females with sensitive skin [2,5].
The mechanism of lichen simplex of the vulva is explained by the persistent itch-scratch cycle. Pre-existing itch or pruritic conditions induce habitual scratching, which give rise to thickening of the epidermis (histological acanthosis) and the stratum corneum (hyperkeratosis). Pruritus may be associated with an underlying systemic disease and/or a predisposing psychiatric condition [2,3,4].
Contributing factors to vulval lichen simplex may include [1,2,5]:
Lichen simplex of the vulva manifests as well-demarcated, markedly thickened plaques with a leathery appearance. It is often unilateral but it may also be bilateral. There may be a solitary plaque or multiple coalescing plaques or papules. There is unremitting pruritus. Other commonly observed features include:
Signs of an underlying skin disorder may also be noted adjacent to lichen simplex of the vulva and/or on another body site.
Lichen simplex can affect other parts of the body. Common sites of involvement are the posterior-lateral neck, scalp, extensor surfaces of extremities, or the ankles/lower legs [1,2,4,5].
Complications of lichen simplex of the vulva may include:
Adverse effects from treatment can also arise, particularly atrophy due to extended use of a potent topical corticosteroid on vulval skin. Topical steroids can also cause pigmentation abnormalities .
The clinical features of vulval lichen simplex are generally sufficient to establish the diagnosis. When findings are atypical, further tests can be considered to make a definitive diagnosis or to exclude other similar dermatoses.
If the vulval lichen simplex is associated with generalised pruritus, a work-up for systemic causes can be undertaken as outlined on our pruritus page.
Other disorders that should be considered in a patient with lichen simplex of the vulva include [1,2,3]:
Treatment for lichen simplex of the vulva involves:
Short-term use of topical corticosteroids are used first line to break the itch-scratch cycle. Treatment principles include using a medium potency topical steroid such as triamcinolone ointment until there is resolution of active lesions. If the disease is refractory after 2–3 weeks of intermediate-strength corticosteroid, more potent topical steroids can be used on a short-term basis. As the condition improves, application frequency and potency of the corticosteroid should be decreased to minimise their adverse effects.
Avoid precipitating factors such as dryness, sweating or excessive moisture, and skin irritation from tight clothes and rough materials. Silk or cotton fabric underwear can be less irritating to vulval skin than synthetic fabrics; however modern fibres that keep moisture away from the skin may be preferred [2,5].
Lichen simplex of the vulva runs a chronic clinical course with exacerbations and remissions. As recurrences occur during psychological stresses or with flareup of underlying dermatoses, long-term management may be required in some patients .
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