Vulva, vagina & female urethra


Lichen planus

Topic Completed: 1 March 2013

Minor changes: 30 April 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Vulva lichen planus [title]

Monika Roychowdhury, M.D.
Page views in 2020: 6,007
Page views in 2021 to date: 5,497
Cite this page: Roychowdhury M. Lichen planus. website. Accessed October 15th, 2021.
Definition / general
  • Also known as Wickham 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: Vulva - Lichen Planus [Accessed 3 October 2017])
  • 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
Clinical features
Clinical images

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Glassy, reticulated, white papules and plaques

Extensive erosion and ulceration

Microscopic (histologic) description
  • 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
Microscopic (histologic) images

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Dense, band-like dermal inflammation

Differential diagnosis
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