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Lichen sclerosus: a potpourri of misdiagnosed cases based on atypical clinical presentations

Authors Ventolini G, Patel R, Vasquez R

Received 14 February 2015

Accepted for publication 2 April 2015

Published 8 May 2015 Volume 2015:7 Pages 511—515


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Elie Al-Chaer

Gary Ventolini, Ravi Patel, Robert Vasquez

Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA

Objective: Lichen sclerosus (LS) is a chronic progressive inflammatory autoimmune-induced disease that primarily affects the epidermis and dermis of the external genital-anal region. Intense and recalcitrant pruritus is the hallmark of LS. Physical exam reveals thinning, hyperkeratosis, and parchment-like appearance. However, the classic symptom and signs of LS may not always be present and patients may be asymptomatic for pruritus. Hence, we describe 15 misdiagnosed cases with atypical clinical presentations. We believe that the absence of pruritus contributed to their initial misdiagnosis. The purpose of this paper is to increase awareness of atypical presentations of LS.
Methods: Data base review of de-identified clinical case pictures was performed. All patients had histopathology-confirmed diagnoses of LS. The data base file contains 800 cases of vulvovaginal disorders. The Institutional Review Board (IRB) considered that searching a de-identified data base of pictures did not require IRB approval.
Results: We identified 15 different atypical clinical cases. Patient ages were 18–75 years old. These patients were asymptomatic for pruritus and were misdiagnosed before they presented to the vulvovaginal specialized clinic.
Conclusion: Fifteen patients asymptomatic for pruritus with histopathology-confirmed diagnosis of LS were identified. They illustrate atypical clinical presentations that LS may have.

Keywords: vulvovaginal, vulvar, atypical, lichen sclerosus, asymptomatic

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