Vulvar Lichen Sclerosus: Diagnosis and Management
Vulvar Lichen Sclerosus: Diagnosis and Management
Vulvar biopsy is the gold standard for confirmation of pathologies such as VLS, SCC, and VIN. Biopsy is mandatory if neoplastic changes are suspected, the condition fails to respond to adequate treatment, extragenital LS is present, pigmented areas indicative of VIN or SCC are present, and when second-line therapy is required. Obtaining a biopsy before initiating treatment with topical corticosteroids is recommended because these medications have been found to interfere with biopsy results. NPs must understand that biopsy is not always essential or practical when the clinical features are typical. However, because LS is a lifelong chronic condition requiring long-term treatment and follow-up, confirmatory biopsy is recommended before initiating treatment.
Although vaginal swabs are not routinely required for the diagnosis of VLS, they may be useful in ruling out concurrent conditions, such as bacterial vaginosis, trichomoniasis, candida vulvovaginitis, herpes simplex virus, and other sexually transmitted infections. Vaginal swabs are primarily collected in the presence of abnormal discharge, vulvar erythema, fissuring, or excoriation. Signs and symptoms such as labial swelling, erythema, and thick white discharge are often easily identified as candida vulvovaginitis. However, practitioners must remain cognizant of possible differential diagnoses, namely VLS, if infection recurs or is unresponsive to antifungal treatment.
Some autoimmune disorders, including thyroid disease, vitiligo, alopecia areata, pernicious anemia, and diabetes mellitus, are common among patients with VLS. Therefore, when clinical signs and/or symptoms suggest an underlying autoimmune disease, additional testing based on the suspected autoimmune disorder is recommended.
Diagnostic Testing
Vulvar Biopsy
Vulvar biopsy is the gold standard for confirmation of pathologies such as VLS, SCC, and VIN. Biopsy is mandatory if neoplastic changes are suspected, the condition fails to respond to adequate treatment, extragenital LS is present, pigmented areas indicative of VIN or SCC are present, and when second-line therapy is required. Obtaining a biopsy before initiating treatment with topical corticosteroids is recommended because these medications have been found to interfere with biopsy results. NPs must understand that biopsy is not always essential or practical when the clinical features are typical. However, because LS is a lifelong chronic condition requiring long-term treatment and follow-up, confirmatory biopsy is recommended before initiating treatment.
Vaginal Swabs
Although vaginal swabs are not routinely required for the diagnosis of VLS, they may be useful in ruling out concurrent conditions, such as bacterial vaginosis, trichomoniasis, candida vulvovaginitis, herpes simplex virus, and other sexually transmitted infections. Vaginal swabs are primarily collected in the presence of abnormal discharge, vulvar erythema, fissuring, or excoriation. Signs and symptoms such as labial swelling, erythema, and thick white discharge are often easily identified as candida vulvovaginitis. However, practitioners must remain cognizant of possible differential diagnoses, namely VLS, if infection recurs or is unresponsive to antifungal treatment.
Immunology
Some autoimmune disorders, including thyroid disease, vitiligo, alopecia areata, pernicious anemia, and diabetes mellitus, are common among patients with VLS. Therefore, when clinical signs and/or symptoms suggest an underlying autoimmune disease, additional testing based on the suspected autoimmune disorder is recommended.
