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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 62-63

Isolated annular genital lichen planus in a female


1 Department of Dermatology, DR RMLH PGIMER, New Delhi, India
2 Department of Pathology, DR RMLH PGIMER, New Delhi, India

Date of Web Publication13-Jun-2019

Correspondence Address:
Seema Rani
Department of Dermatology, DR RMLH PGIMER, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdpdd.ijdpdd_45_18

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How to cite this article:
Singh A, Rani S, Ahuja AK. Isolated annular genital lichen planus in a female. Indian J Dermatopathol Diagn Dermatol 2019;6:62-3

How to cite this URL:
Singh A, Rani S, Ahuja AK. Isolated annular genital lichen planus in a female. Indian J Dermatopathol Diagn Dermatol [serial online] 2019 [cited 2019 Jun 17];6:62-3. Available from: http://www.ijdpdd.com/text.asp?2019/6/1/62/260186



Sir,

Several noninfectious diseases of female genitalia masquerading with other conditions and such cases may land to the sexually transmitted disease (STD) clinic. We report a case of isolated genital annular lichen planus in a female, simulating many benign conditions.

Lichen planus (LP) is a common chronic inflammatory dermatosis of unknown origin that presents in a variety of morphologic patterns. Annular lichen planus is a rarely reported variant of lichen planus. Although annular lesions are frequent in male patients of LP with genital involvement, isolated genital annular LP in females is rarely reported.

A 30-year-old female presented to STD clinic with the complaint of pruritus vulva for 3 months. There was no history of any such illness in the past. Genital examination revealed a single well-defined annular plaque of approximately 1 cm in diameter with raised borders present on the inner surface of the left labium majus. The center of the lesion was slightly atrophic [Figure 1]. There was no cutaneous, oral mucosal, and nail involvement. A differential diagnosis of mucosal LP, porokeratosis, seborrheic keratosis, and granuloma annulare was kept. The histopathological examination from the edge of the plaque showed hyperkeratosis, acanthosis, follicular plugging, spongiosis, lymphocytic exocytosis, vacuolar alteration of basal keratinocytes, and apoptotic keratinocytes [Figure 2]. Dermis showed dermal edema with pigment incontinence, and a band-like chronic lymphocytic infiltrate [Figure 3]. No atypical keratinocytes were seen. Based on the clinicopathological correlation, a diagnosis of isolated annular LP of the vulva was made.
Figure 1: A single well-defined annular plaque with raised borders and slight central atrophy present on the inner surface of the left labium majus

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Figure 2: Low-power photomicrograph of skin biopsy shows hyperkeratosis, follicular plugging, and mild spongiosis. Dermis shows band-like infiltrate in the upper part (H and E, ×1000)

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Figure 3: High power showing band-like lymphocytic infiltrate, vacuolar degeneration of basal cells, melanin pigment incontinence, and melanophages (H and E, ×400)

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The patient was advised to apply topical tacrolimus 0.03% cream twice daily along with oral antihistaminics. She reported symptomatic relief after 2 weeks.

Lichen planus lesions over the female genitalia are fairly common. They may occur alone or in association with lesions in the oral cavity or a part of widespread involvement. The clinical presentation of LP of the vulva spans a spectrum from fine, reticulate papules to severe erosive lesions along with dyspareunia, scarring, and loss of the normal vulvar architecture.[1] The association of erosive LP of the vulva and vagina with desquamative-gingivitis has been termed the vulvovaginal-gingival syndrome.[2] Annular LP is a morphological variant of classic LP. Prevalence of annular variant is approximately 3%–7% of patients with LP, although the true prevalence is likely underestimated.[3] Annular LP lesions clinically present as red to purple circular macules or plaques with raised borders with or without central atrophy. Most cases of annular LP are reported in males. The lesions are frequently present over genital sites such as penis and scrotum and intertriginous regions but are rarely seen over female genitalia. Specific mechanism for the annular morphology of these lesions is not clearly known, although various theories exist. Multiple lichenoid papules may converge in a circinate fashion to form an annular shape. An immunohistochemical study by Ohta showed that expressions of intercellular adhesion molecule 1 and tumor necrosis factor alpha in the peripheral keratinocytes of active LP plaques may play a role in the formation of annular lesions.[4] Other lesions may form as a result of the expansion of a papule or plaque with central involution and an advancing raised border. Although classic LP is symptomatic, annular LP is usually asymptomatic in most patients. However, in our case, it was pruritic. Our report describes LP exclusively localized on the vulva with the rare morphologic presentation of a solitary annular plaque.

A satisfactory response with the use of mild-to-high potency topical steroids is seen in most patients with annular LP.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Edwards L. Vulvar lichen planus. Arch Dermatol 1989;125:1677-80.  Back to cited text no. 1
    
2.
Eisen D. The vulvovaginal-gingival syndrome of lichen planus. The clinical characteristics of 22 patients. Arch Dermatol 1994;130:1379-82.  Back to cited text no. 2
    
3.
Altman J, Perry HO. The variations and course of lichen planus. Arch Dermatol 1961;84:179-91.  Back to cited text no. 3
    
4.
Ohta Y, Yonemoto K, Asai T, Yaguchi A. Lichen planus annularis: An immunohistochemical study. J Dermatol 1992;19:414-9.  Back to cited text no. 4
    
5.
Reich HL, Nguyen JT, James WD. Annular lichen planus: A case series of 20 patients. J Am Acad Dermatol 2004;50:595-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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