title: Comorbid Vulvar Lichen Planus and Lichen Sclerosus.
abstract: OBJECTIVE
  The aims of the study are to assess the histopathologic characteristics of vulvar biopsies consistent with lichen planus (LP) in women with a previous or concurrent histopathologic diagnosis of vulvar lichen sclerosus (LS) and to describe the clinical features of comorbid LP and LS.
  
  
  METHODS
  Patients were included if a diagnosis of LP was confirmed after review of the hematoxylin and eosin slides and the histopathology reporting LS noted a band of abnormal collagen. Data were collected on anatomic site, clinical appearance, histopathology, microbiology, treatment, and follow-up.
  
  
  RESULTS
  There were 31 cases with a mean age of 69.5 years. Thirty specimens showed erosive LP, of which 22 were from inner labium minus and 8 from vestibule. There were no significant differences between biopsy site in epithelial thickness, erosion, lymphocytic infiltrate, or basal layer pattern. One third of cases showed a regenerative pattern of LP. Of the 26 patients with clinical records available, erythema at the biopsy site was noted in all cases; in 23 the notes specified central erythema and peripheral pallor. Forty-six percent were prescribed topical corticosteroids before biopsy. All 26 were treated with topical corticosteroids, 23% were prescribed antimycotics, and 38% required other supplemental therapies.
  
  
  CONCLUSIONS
  Comorbid vulvar LP and LS are not rare; clinicians suspecting one should evaluate for the other and consider separate biopsies of morphologically distinct areas. Clinicopathological correlation is an invaluable tool in assessing biopsies when both diagnoses are suspected, because the regenerative pattern of LP may otherwise be overlooked or misdiagnosed.
authors.affiliation: 1Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia; 2Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia; 3Solo Private Practice, Victoria, Australia; and 4Anatomical Pathology, Pathology North, Hunter New England, Newcastle, New South Wales, Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Day
authors.forename: Sarah
authors.initials: S
authors.lastname: Moore
authors.forename: Tanja Gizela
authors.initials: TG
authors.lastname: Bohl
authors.forename: James
authors.initials: J
authors.lastname: Scurry
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D015897:Comorbidity; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008010:Lichen Planus / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D008853:Microscopy; D008875:Middle Aged; D014844:Vulva / Q000473:pathology*
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents