Case reportErosive lichen planus of the vulva and vagina
Section snippets
Case 1
A 55-year-old multiparous woman presented with a 5-year history of vulvovaginal symptoms. She had initially experienced introital dyspareunia with bleeding and subsequently had a gradual onset of vulvar burning and itching. Intercourse became more and more difficult and eventually impossible. The patient had been treated on several occasions for presumed yeast infection and bacterial vaginosis. Her more recent treatment was a vaginal dilator with estrogen cream, which had not produced any
Case 2
A 55-year-old multiparous woman presented with a 7-year history of progressive vaginal narrowing. For the last 6 months, sexual intercourse had been impossible. In addition, she experienced intermittent burning and itching of the vaginal introitus. She had undergone three previous vaginoplasties performed by different gynecologists in attempts to restore patency, but each time the procedures were followed by restenosis within a few months.
Her most significant medical history was lichen planus
Case 3
A 49-year-old, gravida 1, para 1, woman presented with a 3-year history of vulvovaginal symptoms. Her first symptom was introital dyspareunia, followed by a gradual onset of burning, itching, and soreness. Her husband noted visible erythema in her vestibule and also gave a clear description of the gradual formation of adhesive bands in the vagina. The vagina narrowed progressively until it was essentially closed, and intercourse had been impossible for the past year. A biopsy performed by a
Comment
Lichen planus is believed to be caused by a disorder of cell-mediated immunity.1 The classic form of the disease is cutaneous, producing pruritic, violaceous, flat-topped papules on the skin of the body, including the skin of the genital area in both sexes, but many clinical variants exist. The erosive form is well recognized and occurs in the mouth, the vulva and vagina, and the glans penis. In women, erosive lichen planus may affect the labia minora, vaginal vestibule, and the whole length of
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Genital Lichen Sclerosus and its Mimics
2017, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :ELP also usually involves the vagina in the form of erythematous and friable lesions, inflammatory vaginal discharge, or synechiae, which can be extensive to the point of complete obliteration. Whereas most cases of VLS are adequately controlled with return to baseline function, ELP can be more devastating both sexually and physically.23 A punch biopsy can be helpful to distinguish between these disorders, but histologic findings may be similar.
Lichenoid vulvar disease: A review
2017, International Journal of Women's DermatologyCitation Excerpt :In 1982, Pelisse et al. designated the term vulvovaginal gingival syndrome for vulvovaginal LP with concomitant oral involvement (Eisen, 1994; Pelisse et al., 1982). Desquamative inflammatory vaginitis (DIV) had been used to describe cases of erosive vulvovaginal LP; however, DIV now refers to a distinct entity that can have overlapping signs and symptoms with vulvovaginal LP (Lotery and Galask, 2003). Large population-based studies that describe the epidemiology of vulvar LP (VLP) are lacking.
Sexual dysfunction in women with cancer
2013, Fertility and SterilityCitation Excerpt :Most physicians treat initially with a topical steroid. If this is not effective, use of topical cyclosporine has been reported (44); vaginal tacrolimus has been tolerated in women treated for lichen planus, but has not been studied in GVHD (45). Women with vaginal adhesions may benefit from vaginal dilator therapy or surgery.
Treatment of vulvovaginal lichen planus
2010, Dermatologic ClinicsCitation Excerpt :All patients reported significant improvement. Of the 3 patients, 2 used a graduated vaginal dilator coated with a vaginal estrogen cream, with increased diameter and depth of dilator insertion as well as the ability to resume sexual intercourse.25 Another small case series from Finland reported on 5 patients with stenosing LP treated with methotrexate supplemented with ultrapotent corticosteroid cream and tacrolimus in combination with surgical dilatation.
Female genital tract chronic graft-versus-host disease: A narrative review
2019, Hematology, Transfusion and Cell TherapyCitation Excerpt :The use of hydrocortisone (25 mg suppositories) or suppositories with 1 mg of estriol twice daily is recommended, decreasing the dose once the symptoms have been controlled, then maintaining twice-weekly administrations and gradually reducing the dose until complete suspension.30 An alternative to suppositories is the application of corticosteroid (hydrocortisone 25 mg) with a penile prosthesis to prevent the formation of synechiae.27,30 In a series of 11 patients, Spiryda et al.15 described the use of vaginal cream consisting of a 200 mg oral suspension of cyclosporine diluted in an oily base twice daily for four weeks followed by weaning for two months.
Vulvar lichen planus–induced vulvovaginal stenosis: A case report and review of the literature
2023, SAGE Open Medical Case Reports