Clinicopathologic Overlap of Vulvar Vitiligo With Lichen Sclerosus and Dermatitis

Objectives The aims of the study were to describe clinicopathologic features of vulvar biopsies diagnostic for vitiligo and assess the link between vitiligo and genital symptoms. Methods The pathology database identified vulvar biopsies showing vitiligo, defined as absent or rare melanocytes on HMB-45, Sox-10, or Melan-A stains. Inclusion criteria were age 18 or over and availability of slides and medical records. Clinical data included demographics, comorbid conditions, symptoms, examination, treatment, and response. Histopathologic review documented site, epidermal characteristics, dermal collagen change, and lymphocytic infiltrate. Cases were stratified by histologic evidence of lichenoid dermatosis. Results Vulvar biopsies demonstrated vitiligo in 36 women with a median age of 56 years. Simultaneous histologic diagnosis of lichen sclerosus (LS) or lichenoid dermatitis was present in 23 (64%). Seven (19%) showed otherwise normal skin, while 5 (14%) had lichen simplex chronicus and 1 (3%) had spongiotic dermatitis. Itch was more frequent in the lichenoid group [21/23 (91%) vs 6/13 (46%); p = .005], while asymptomatic status was more likely in the normal/dermatitis group [5/13 (38%) vs 2/23 (9%); p = .001]. Three of 7 (43%) women with isolated histologic vitiligo reported pain and/or itch; 2 of their clinicians provided topical steroid maintenance and follow-up for presumed LS. Of 19 women with histologic LS, 11 (58%) lacked basal layer degeneration, of whom 6 (54%) reported concurrent topical steroid or calcineurin inhibitor use. Conclusions Symptomatic women with biopsy-proven vulvar vitiligo usually have an additional dermatologic condition, but histopathologic diagnosis of overlapping conditions is complicated by basal layer assessment and nonsclerotic LS.