Erosive Lichen Planus
Lichen planus is a chronic T-cell mediated inflammatory condition primarily affecting the mucosal surfaces such as the oral mucosa and the anogenital region 1. Vulvar lichen planus may present with multiple morphologies with the most common being the erosive subtype [85%] 2,3 and carries a 2-3% risk of malignant progression4-6. This subtype presents with white, “lacy” edged erosions of symmetrical distribution extending from the fourchette to the anterior vestibule also known as Wickham’s striae. Frequent symptoms include soreness, pain and dyspareunia. If untreated, it may result in vulvovaginal synechiae formation, clitoral and urethral burying and eventually vaginal stenosis5,7-10. Treatment typically most often involves topical treatment including the use of very potent topical steroids such as clobetasol proprionate & tacrolimus followed by systemic steroids or immunosuppressants such as a hydroxychloroquine, methotrexate11-16 or mycophenolate mofetil17 with controversy over the appropriate management If there is significant vaginal stenosis affecting sexual function and micturition 9,18,19.