title: Lichen sclerosus: a potpourri of misdiagnosed cases based on atypical clinical presentations.
abstract: 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.
  
  
  CONCLUSIONS
  Fifteen patients asymptomatic for pruritus with histopathology-confirmed diagnosis of LS were identified. They illustrate atypical clinical presentations that LS may have.
authors.affiliation: Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Ventolini
authors.affiliation: Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Patel
authors.affiliation: Texas Tech University Health Sciences Center Permian Basin, Odessa, TX, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Vasquez
keywords: asymptomatic; atypical; lichen sclerosus; vulvar; vulvovaginal