Differential Clinical Signatures of Vulvar Lichen Sclerosus, Lichen Planus, and Chronic Lichen Simplex: A Comparative Study in 1355 Patients.

BACKGROUND

Vulvar lichen sclerosus (VLS), vulvar lichen planus (VLP), and vulvar lichen simplex chronicus (VLSC) are inflammatory dermatoses with overlapping clinical features, posing diagnostic challenges. VLS and VLP carry malignant potential, unlike VLSC. Comparative studies are limited despite frequent misclassification.

OBJECTIVE

To compare the clinical characteristics of VLS, VLP, and VLSC and identify distinguishing diagnostic features.

METHODS

A retrospective study was conducted on clinical data from patients diagnosed with VLS, VLP, or VLSC at the Beijing Hospital Vulvar Clinic (March 2017-August 2024). Epidemiological data, symptoms, and physical findings were compared.

RESULTS

Patients with VLP had a significantly higher median onset age (44 years) than VLS (30 years) or VLSC (34 years) (P<0.001). Diagnostic delay was longest in VLS (median 5 years vs 3 years for VLP/VLSC). Pruritus prevalence and intensity (median Numerical Rating Scale [NRS]) were highest in VLSC (100%; NRS 7), followed by VLS (92%; NRS 5) and VLP (60%; NRS 2). Pain was most frequent in VLP (79%) vs VLS (14%) and VLSC (<1%). VLSC patients reported the highest mean Dermatology Life Quality Index scores (8.67), driven by severe pruritus. Sexual dysfunction was common in both VLS (81%) and VLP (85%). Anatomically, VLS primarily affected the clitoris, labia minora, and interlabial sulci; VLSC predominantly involved the labia majora and perianal region. Vaginal introitus involvement characterized VLP (90%). Lesion morphology differed: VLS featured white patches (84%) and lichenification (61%), VLP erosion (76%), and VLSC marked lichenification (89%).

CONCLUSION

VLS, VLP, and VLSC exhibit distinct differences in age of onset, clinical manifestations, lesion morphology, and anatomical distribution despite clinical overlap. Recognizing these features facilitates accurate diagnosis, guides individualized treatment, improves long-term outcomes, and enables early detection of malignant potential in VLS/VLP.