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.