Vulvar lichen sclerosus (LS) and lichen planus (LP) are chronic inflammatory dermatoses that significantly impair quality of life through pruritus, pain, sexual dysfunction, and risk of scarring or malignancy. Although they share lichenoid histopathologic features, LS primarily affects keratinized skin, while LP commonly involves mucosal surfaces and may present with erosive, papulosquamous, or hypertrophic variants. Disease underrecognition often delays diagnosis and treatment. This review summarizes the epidemiology, pathophysiology, clinical presentation, histopathology, and management of vulvar LS and LP, highlighting distinguishing features, areas of diagnostic overlap, and best practices to optimize outcomes and prevent long-term complications.

Concurrent Vulvar Vitiligo and Lichen Sclerosus: The Importance of Melanocyte-Specific Immunostains in Resolving Diagnostic Ambiguity

ABSTRACT Background Vulval Lichen Sclerosus (VLS) is a chronic inflammatory condition requiring lifelong management to prevent severe complications including malignancy. A shared care model between general practitioners (GPs) and public non‐GP specialists (dermatologist or gynaecologist) for patients with stable LS would alleviate the demand on public vulval services. This study aims to assess GPs' level of comfort in performing vulval examinations for patients with VLS which would underpin the feasibility of shared care. It also explores GPs' level of confidence in vulval health, preferences for future vulval training and perspectives on rapid access pathways which would enable a successful shared care approach. Method Online survey invitations were sent to GPs across South Australia via email, GP social media groups and health network newsletters between October and December 2024. Survey questions focused on GPs' prior training, confidence in assessing LS, preferences for additional training and referral pathways. Descriptive statistics were used to describe survey responses while Chi‐squared and Fisher's exact test statistical methods were used to identify associations between explanatory variables and outcome variables. Additional binary logistic regression analysis was used to model odds ratios, confidence intervals and corresponding p ‐values for associations between the dependent and independent variables. Results A total of 132 complete responses were received. 74% of GPs were comfortable undertaking vulval examinations for patients with VLS while 26% were not. Stage of training, scope of practice and previous additional training in women's health had statistically significant associations ( p < 0.05) with this outcome. Detecting malignancy and performing vulval biopsy were skills with lower reported levels of confidence. Most GPs desired future upskilling in vulval health, particularly in the form of specialist led face‐to‐face and webinar‐based education, while the most preferred rapid access pathway was an e‐referral (or email) with a phone call to the specialty registrar as needed. If additional training, resources and rapid access pathways were provided, most GPs (91%) were inclined to participate in shared care. Conclusion Most GPs in this study were comfortable in undertaking vulval examinations for patients with VLS and expressed an inclination to participate in shared care. Further efforts are required to provide GPs with additional training and rapid access pathways for specialist input to facilitate a safe and effective shared care model.

The German-language, consensus- and evidence-based S3 guideline on lichen sclerosus (LS) was developed based on the European "EuroGuiDerm Guideline on lichen sclerosus" under the leadership of the German Dermatological Society (DDG) and the German Society for Gynecology and Obstetrics (DGGG). Particular emphasis was placed on adapting the recommendations to the healthcare conditions in German-speaking countries. The interdisciplinary guideline development group consisted of 24 experts from 16 medical societies and actively included patient representatives in the development process. The guideline provides comprehensive recommendations on diagnosis, patient management, follow-up care, and patient education, as well as the treatment of both genital and extragenital LS in women, men, girls, and boys. Regardless of age or sex, ultrapotent or potent topical glucocorticosteroids in combination with emollients remain the standard therapy for genital LS. In male patients with LS-associated phimosis who do not respond sufficiently to standard therapy, circumcision with complete removal of the foreskin is indicated. For extragenital LS, phototherapy with UV light is recommended as an adjunct to topical treatment. Topical calcineurin inhibitors are second-line therapy.

Spatial and Single-Cell Transcriptomics Reveal Keratinocytes as Key Players in Vulvar Lichen Sclerosus Pathogenesis.

P0340 Alteration of microbiome in boys with phimosis with histological proof of Lichen sclerosus: A prospective study

P0057 Lichen sclerosus as an etiological factor of phimosis. Prevalence and results of combined treatment.

Vulvar lichen sclerosus (VLS), erosive vulvar lichen planus (EVLP), and vulvar lichen simplex chronicus (VLSC) are the most common vulvar lichenoid dermatoses. They are frequently misdiagnosed in clinical practice and comparative studies among them remain limited. To analyze the clinical characteristics and quality of life (QoL) burden among these three conditions, raising awareness on these distressing vulvar diseases. This retrospective cross-sectional study analyzed clinical registration data of adult patients diagnosed with VLS, EVLP, or VLSC at a single-center vulvar outpatient department from 2017 to 2025. The vulva was divided into nine anatomical regions to identify predilection sites. QoL was evaluated using either the Dermatology Life Quality Index (DLQI) or Vulvar Quality of Life Index (VQLI). Statistical analyses were conducted using GraphPad Prism version 8.2.1. This study included a total of 1,177 patients, comprising 682 patients with VLS, 429 patients with VLSC, and 66 patients with EVLP. The predilection sites varied among three diseases: the labia minora along with interlabial sulcus in VLS; the labia majora along with interlabial sulcus in VLSC; the labia minora along with vaginal opening in EVLP. A total of 941 patients were assessed using the DLQI. The median DLQI scores were 6.0 for VLS, 7.0 for VLSC, and 7.0 for EVLP, indicating a moderate effect on QoL. The remaining 236 patients were evaluated using the VQLI. The median VQLI scores were 12.0 for VLS, 13.0 for VLSC (indicating a mild impact on QoL), and 19.0 for EVLP, reflecting a moderate impact. The most affected domains included symptoms, feelings and emotions, and future health concerns (VLS and VLSC) or sex function (EVLP). Clinicians and patients should pay more attention to vulvar lichenoid dermatoses, especially EVLP. Early diagnosis and treatment to improve clinical symptoms and relieve discomfort is essential to enhance the QoL.

This study aimed to investigate cellular composition and gene/pathway alterations in VLS tissue compared with normal skin using single-cell RNA sequencing (scRNA-seq) and lipid metabolomics. scRNA-seq was conducted on 4 VLS samples and self-control vulvar skin. Lipid metabolism analysis was performed on 15 VLS samples. Bioinformatics assessed cellular abundance, differentially expressed genes (DEGs), and functional pathways between VLS and normal tissues. DEGs were validated via immunofluorescence. We found significant changes in cell-type abundance in the LS samples, with increased abundance of T cells, particularly the C01-GZMB/GZMK and C05-GNLY/XCL1 T cell subsets, and decreased abundance of fibroblasts, keratinocytes, and melanocytes. Furthermore, scRNA-seq data indicated distinct trends in the expression of key metabolic and inflammatory genes. Notably, lymphocyte-mediated immunity, leukocyte-mediated cytotoxicity, and cell-killing pathways were upregulated in the T cells of VLS, suggesting an ongoing inflammatory milieu. Cell communication analysis revealed an increase in the interactions among cell types, with the interaction intensity between T cells and fibroblasts showing the most pronounced increase. Immunofluorescence results revealed that GZMB and the pro-inflammatory factors, IFN-γ and TNF-β, were significantly increased in the VLS tissues. The epidermal keratin expression in the VLS tissue was abnormal, and the basal layer of the VLS tissue lost its normal single-layer structure, and the arrangement was disordered. Cellular composition changes in VLS T cells lead to apoptosis of normal skin cells, contributing to skin tissue destruction and playing a critical role in the inflammatory development of the disease.

Effective Treatment of Genital Lichen Sclerosus with Tofacitinib: A Retrospective Case Series of 13 Patients.

This study investigated the clinical features, misdiagnosis patterns, and treatment outcomes of vulvar lichen sclerosus (VLS) in girls through a single-center, observational, retrospective cohort analysis of 105 pediatric patients diagnosed at Beijing Children's Hospital between January 2021 and September 2024. The results showed a mean age of onset of (5.47±2.13) years (median: 5 years) and a misdiagnosis rate of 29.52% (31/105), with vitiligo being the most frequent initial misdiagnosis (20.95%, 22/105). Lesions predominantly presented in a "figure-of-8" pattern involving both the vulva and perianal regions (45.71%, 48/105), with symmetrical hypopigmented or depigmented patches observed in most cases (96.19%, 101/105). Subjective symptoms were reported by 49.52% (52/105) of patients, most commonly pruritus (32.40%, 34/105). Dermoscopy revealed whitish to yellowish structureless areas in all examined cases (100%, 30/30) and purpuric globules in 70% (21/30). Histopathological examination consistently demonstrated the characteristic"sandwich-like"pattern of hyperkeratosis, homogenization of dermal collagen, and band-like lymphocytic infiltration. Regarding treatment, the median time to lesion remission was 4 months for topical calcineurin inhibitor monotherapy and 3 months for combination therapy with a topical corticosteroid, while the median time to symptom relief was 2 months and 3 months, respectively. In conclusion, this study indicates that pediatric VLS in this cohort presented at a relatively early age with a high misdiagnosis rate, typically manifesting as symmetrical hypopigmented patches in a vulvo-perianal distribution. Dermoscopy and histopathology are valuable adjuncts for early diagnosis, and standardized treatment effectively alleviates symptoms.

To evaluate the efficacy of long-term outcomes and compare the differences between oral mucosal grafts (OMGs) and colonic mucosal grafts (CMGs) in the treatment of complex long-segment urethral stenosis. We conducted a retrospective analysis of patients with long-segment urethral strictures (> 10cm) who underwent one-stage urethroplasty using either CMGs or OMGs at multiple institutions between 2000 and 2020 in China. Urethral reconstruction with CMGs was performed in 69 patients, while OMG-based urethroplasty was conducted in 225 patients. The primary measure of success was defined as normal voiding and urethrogram results without the need for any postoperative interventions, such as dilations. In the CMG group, urethroplasty procedures ranged from 11 to 21cm in length (mean: 17.3cm), achieving an overall success rate of 85.5% (59/69) with a mean follow-up duration of 145months (range: 20-258months). For the OMG group, urethroplasty lengths ranged from 11 to 20cm (mean: 13.6cm), with an overall success rate of 81.8% (184/225) and a mean follow-up duration of 58months (range: 13-150months). A key limitation of the study was the absence of tools to assess patients' quality of life. Our findings suggest that both CMGs and OMGs are excellent materials for substitution urethroplasty, with both techniques proving effective for managing severe panurethral strictures. The most common complication was meatal stenosis, particularly in patients with lichen sclerosis (LS).

Vulvar Lichen Sclerosus (VLS) is a chronic inflammatory dermatosis of unknown etiology affecting the external genitalia. In pediatric patients, it can lead to significant discomfort and progressive structural changes in tissues. In recent years, there has been increasing interest in the participation of immune checkpoints and inflammatory mediators in the pathogenesis of chronic diseases, including VLS. Immune checkpoints, such as PD-1, PD-L1, CTLA-4, CD200, and CD200R, play a crucial role in modulating the immune response and may serve as potential diagnostic markers and therapeutic targets. This study aimed to evaluate the expression of PD-1, PD-L1, CTLA-4, CD200, and CD200R molecules on CD4+ T cells, CD8+ T cells, and CD19+ B lymphocytes in prepubertal girls diagnosed with VLS. Additionally, the concentrations of their soluble forms and the levels of proinflammatory cytokines, including IL-2, IL-6, and TNF-α, in serum were determined to assess their potential as diagnostic biomarkers. The study included patients with VLS (study group) and healthy children (control group). The expression of checkpoints was analyzed using flow cytometry, while the concentrations of soluble forms and cytokines were determined using the enzyme-linked immunosorbent assay (ELISA) technique. Statistical significance tests and Spearman's rank correlation analysis were used. Patients with VLS showed markedly higher serum C-reactive protein (CRP) levels compared with healthy controls (49.99 ± 6.09mg/L vs. 2.70 ± 0.96mg/L, p < 0.001). A significant increase in checkpoint expression was observed on lymphocyte subsets, including CD4+ T cells expressing PD-1 (4.90 ± 1.67% vs. 0.85 ± 0.56%, p < 0.001) and CTLA-4 (11.58 ± 4.70% vs. 0.96 ± 0.48%, p < 0.001), as well as CD8+ T cells expressing PD-1 (17.31 ± 4.81% vs. 0.76 ± 0.67%, p < 0.001) and CD19+ B cells expressing PD-L1 (16.10 ± 9.50% vs. 1.41 ± 0.45%, p < 0.001). Soluble checkpoint molecules were consistently elevated, for example, sPD-1 (26.69 ± 3.88pg/mL vs. 4.40 ± 0.75pg/mL, p < 0.001) and sCTLA-4 (43.96 ± 3.77pg/mL vs. 5.09 ± 1.09pg/mL, p < 0.001). Similarly, cytokine levels were significantly increased in VLS patients, including interleukin-2 (28.80 ± 6.36pg/mL vs. 4.32 ± 1.33pg/mL, p < 0.001), interleukin-6 (25.35 ± 7.52pg/mL vs. 2.35 ± 0.78pg/mL, p < 0.001), and tumor necrosis factor alpha (31.26 ± 3.10pg/mL vs. 12.80 ± 1.30pg/mL, p < 0.001). Correlation analyses confirmed significant positive associations between cytokine concentrations and checkpoint expression, highlighting their interdependence in VLS immunopathogenesis. The obtained results confirm an increased immunoactivation profile in children with VLS, characterized by elevated checkpoint expression and increased levels of proinflammatory cytokines. The studied parameters show potential as diagnostic and prognostic biomarkers, which may constitute the basis for the development of new diagnostic tools and targeted therapeutic strategies in VLS in pediatric patients.

Vulval lichen sclerosus (LS) is a chronic inflammatory dermatosis with recognised associations with autoimmune disease, including thyroid disease, vitiligo, and psoriasis. Current expert consensus guidelines recommend investigating for autoimmune disease when clinically indicated by symptoms or signs. More recently, focused screening for thyroid disease and pernicious anaemia in women with LS has been proposed. This study aimed to assess the prevalence of autoimmune disease in a tertiary multidisciplinary vulval clinic and to determine whether findings from this cohort provide support for these proposed screening recommendations. A retrospective review of electronic medical records was conducted for patients attending a tertiary women's hospital vulval dermatology service between August 2020 and June 2025 with a diagnosis of LS. Data extracted included autoimmune history, serological testing for autoimmune disease (including thyroid function and pernicious anaemia), and family history. Descriptive statistics were used for analysis. Eight hundred fifty-one patients met inclusion criteria. Autoimmune disease was recorded in 31.7%, with autoimmune thyroid disease (12.5%), lichen planus (8.23%), and psoriasis (5.05%) being most common. Inflammatory arthritis was present in 4.8% and autoimmune dermatological conditions in 18.4%. Serological screening was performed infrequently; thyroid stimulating hormone was performed in 18.4% of patients without known thyroid disease and 6.5% of these were abnormal. Vitamin B12 screening was performed in 8.9% and 10.5% were abnormal. Pernicious anaemia antibodies were performed in 0.35% and all were negative. This single-centre cohort study demonstrated a high prevalence of autoimmune disease in women with LS, particularly thyroid disease, providing support for consideration of thyroid stimulating hormone screening. Serological testing for autoimmune disease was infrequently documented in this cohort, and the limited data on pernicious anaemia were insufficient to evaluate the proposed recommendation. The findings also highlight a high burden of autoimmune arthritis and other dermatological conditions, suggesting a role for clinical assessment in these domains. Prospective multicentre studies are required to inform and refine screening recommendations.

There have only been a limited number of case reports that have described vulval lichen sclerosus in patients receiving immune checkpoint inhibitor (ICI) therapy. We describe 11 cases of vulval lichen sclerosus in patients with melanoma treated with ICIs, and in nine of these cases, the lichen sclerosus symptoms began after ICI commencement. This represents the largest reported series to date and highlights the need for clinician awareness of this potential immune-related adverse effect.

Clinical and histological predictors of disease severity in boys with lichen sclerosus: A prospective multicentre observational study.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition predominantly affecting postmenopausal women, often leading to significant discomfort and impaired quality of life. Current treatments, such as topical corticosteroids, have limitations in efficacy and long-term safety. Fractional CO2 laser therapy has emerged as a promising modality for managing VLS, but its combination with topical estrogen remains underexplored. This study aimed to evaluate the efficacy and safety of combined fractional CO2 laser and topical estrogen therapy in managing VLS in postmenopausal women. A randomized controlled trial was conducted involving 60 postmenopausal women diagnosed with VLS. Participants were divided into two groups: the intervention group received fractional CO2 laser therapy combined with topical estrogen ointment, while the control group received topical estrogen alone. Efficacy was defined as a significant reduction in vulvar lichen sclerosus symptom score (VLSSS), assessed at baseline, 3 months, and 6 months. Secondary outcomes included histopathological changes and patient-reported quality of life measures. At both 3 months and 1 year after treatment, the intervention group showed a significant reduction in VLSSS compared to the control group (p < 0.001). Histopathological analysis demonstrated reduced inflammation and fibrosis. Patient-reported outcomes revealed significant improvements in sexual function (FSFI) and quality of life (CECA10) in the combined therapy group. Additionally, the recurrence rate at 1 year was significantly lower in the intervention group (17.14%) than in the control group (31.43%, p < 0.001). No severe adverse events were reported. The study's sample size was relatively small, and the follow-up period was limited to 6 months, which may not capture long-term outcomes. Additionally, the single-center design may limit generalizability. Combined fractional CO2 laser and topical estrogen therapy is a safe and effective approach for managing VLS in postmenopausal women, offering significant symptom relief and improved quality of life. Further studies with larger cohorts and longer follow-up are warranted to confirm these findings.

Platelet-Rich Plasma in the Management of Genital Lichen Sclerosus: A Review of Mechanisms, Evidence, and Future Directions.

Perspectives of boys, families & surgeons: Preputioplasty vs. circumcision for treatment of lichen sclerosus.

Histomorphology and utility of CK17, p53 dual stain with CK 13 in the diagnosis of differentiated vulvar intraepithelial neoplasia.