Lichen planus presenting as pruritus vulvae

Abstract

A 53-year-old Caucasian woman presented with a 12month history of vulval discomfort. This began as intense pruritus and the symptoms continued to become worse. She then complained of severe pain necessitating regular oral analgesia. Attempted sexual intercourse was painful and resulted in apareunia. The patient had consulted her general practitioner on several occasions and topical oestrogens or antifungal, with mild steroids (e.g. daktacort), creams were prescribed. There had been no response to repeated courses of these preparations. On referral, examination revealed an acute erosive lower vaginitis. There was extensive scarring and the introitus was stenosed and the vagina shortened. Systemic enquiry confirmed that the patient had been diagnosed as having oral lichen planus earlier that same year. The patient was admitted for vulval biopsy under general anaesthesia, due to the severity of her symptoms and clinical findings. Histology supported the diagnosis of vulval lichen planus (Figs 1 & 2). Her postoperative course was complicated by acute urinary retention secondary to the formation of labial adhesions. These were manually freed and the patient was commenced on oral prednisolone 30 mg/day and topical clobetasol propionate (Dermovate). She improved considerably over the course of 3 days and was discharged home on oral steroids and topical clobetasol. Her condition continued to improve and after 8 weeks of oral steroids she was weaned off this medication. The topical clobetasol propionate was changed to the tess potent steroid betamethasone valerate (Betnovate). Her disease continues to be in remission.