General
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• Unrelated disorders of epithelial growth that present as irregular patchy areas of thickened skin and severe itching
• Types:
  • Squamous cell hyperplasia (most common form)
  • Lichen Sclerosus
  • Other dermatoses (e.g. psoriasis and lichen planus, skin changes secondary to chronic infections)
• Often white skin (leukoplakia), but may be red
• Easily traumatized
• Suggested to diagnose as dermatosis, not as vulvar dystrophy (Mod Pathol 1997;10:401)

Etiology
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• Many inciting factors, including skin infections and skin irritants
• However, once established, patient’s natural itch-scratch cycle can perpetuate the problem

Clinical features
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• Grey or white patches
• Vulvar skin becomes too thick or too thin
• Frequently extreme burning or itching

Diagnosis
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• Clinical examination
• Further classified based on biopsy findings

Prognostic factors
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• Most lesions have no premalignant potential, but if dysplasia is present, can be associated with a low risk for squamous cell carcinoma

Treatment
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• Corticosteroid cream

Gross images
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Hypertrophic vulvar dystrophy

Mixed dystrophy

White epithelium with atrophic labia majora

Micro description
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• Lichen sclerosus
  • Epidermal and dermal atrophy
  • Thinning of epithelium with blunting/loss of rete pegs
  • Superficial dermal chronic inflammation
  • In late stages, there is band like hyalinization of dermal collagen
• Squamous hyperplasia
  • Epithelial thickening with acanthosis, hyperkeratosis or parakeratosis
  • Nuclear atypia not seen

Micro images
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Mild hyperkeratosis

Epithelial thickening

Chronic inflammatory cell infiltrate

Squamous hyperplasia

Additional references
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• Well Woman Clinic - Dystrophis, University of Virginia - Non-neoplastic Epithelial Disorders

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