• Also known as Wickham's striae, an inflammatory autoimmune disorder involving keratinized and mucosal surfaces
• Symptoms: white, lacy, reticular lesion, itching, burning, postcoital bleeding, dyspareunia and pain (University of Michigan)
• Itching causes hyperkeratosis
• Chronic, recurring, relapsing, involves the vagina in up to 70% of patients (can result in friable hemorrhagic tissue causing yellowish discharge)
• Rarely have oral lesions (resulting in vulvovaginal-gingival syndrome)
• Due to low risk of squamous cell carcinoma, examine patients regularly, biopsy persistent lesions

• Overall rare, incidence peaks between ages 30-60

• Three clinical variants: erosive (most common), papulosquamous, hypertrophic (Am Fam Physician 2008;77:321)

Glassy, reticulated, white papules and plaques

Extensive erosion and ulceration

• Lymphocytic infiltrate (without plasma cells) with lichenoid pattern involving superficial dermis and extending into basilar and parabasilar epithelium
• Liquefaction necrosis and colloid bodies may be present within basal epithelial cells
• Epithelium may have prominent acanthosis with prominent granular layer and hyperkeratosis
• In older lesions, acanthosis may be absent and epithelium may be thinned with loss of rete ridges
• Ulceration and bullae may occur in severe lesions
• In nonkeratinized epithelium of vestibule, inflammatory infiltrate may contain plasma cells; hyperkeratosis and prominent granular layer are usually absent

Dense, band-like dermal inflammation

Oral lichen planus

• Behçet's syndrome
• Desquamative inflammatory vaginitis
• Graft-versus-host disease: immunofluorescence studies may be performed to rule out pemphigus and pemphigoid
• Lichen sclerosus
• Lichenoid drug reactions
• Mucous membrane pemphigoid
• Pemphigus vulgaris

• Br J Dermatol 1998;138:569, J Midwifery Womens Health 2012;57:260

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