Vulva Lichen Sclerosus

In 1987, the international society for the study of vulvovaginal diseases proposed a classification for the non-neoplastic epithelial disorders of the vulvar skin and mucosa. These entities had previously been incorporated under the designation of vulvar dystrophies. This new classification in contrast to the prior classification, which has been based purely on histopathologic features of the lesions, was based on gross and histopathologic features. It is as follows:

  1. Squamous cell hyperplasia (formerly hyperplastic dystrophy).
  2. Lichen sclerosus.
  3. Other dermatoses.
Lichen sclerosus has formerly been broken down into two subgroups including pure lichen sclerosus and lichen sclerosus associated with squamous cell hyperplasia classified as a mixed dystrophy. The current classification recommends that lichen sclerosus with associated squamous cell hyperplasia should be reported as such rather than as a mixed dystrophy. Epithelial lesions associated with cellular atypia are currently classified under vulvar intraepithelial neoplasia. In most instances a clinical impression can be established on the basis of gross inspection alone, however, this is not always possible and classification of the lesion may be dependent upon its microscopic features. This is important, since the management of the patient will vary significantly depending upon the disease being treated.

Lichen sclerosus was first described by Henri Hallopeau in 1897 who referred to it as lichen planus atrophicus. Lichen sclerosus represents a specific dermatological entity. It is most commonly seen in the genital area in women. It may also be found on other sites of the body. The gross and microscopic appearance and the clinical course of lichen sclerosus are characteristic.

Lichen sclerosus is primarily a disease of the postmenopausal woman, however, it can be seen at any age and not uncommonly is even seen in children (Fig. 1).


Childhood LS FPX Thumbnail of Childhood Lichen Sclerosus - Click Hyperlink to Enlarge
Early LS FPX Thumbnail of Early Adult Lichen Sclerosus - Click Hyperlink to Enlarge
Advanced LSFPX Thumbnail of Advanced Adult Lichen Sclerosus - Click Hyperlink to Enlarge


"Classic" LS  FPX Thumbnail of Lichen Sclerosus Histology - Click Hyperlink to Enlarge