Key points for distinguishing vulvar leukoplakia from perineal vitiligo

There is a certain degree of similarity in the clinical manifestations between vulvar leukoplakia and perineal vitiligo. Careful differentiation is required during diagnosis to prevent misdiagnosis and delay in treatment of the disease. The key points for differentiating vulvar leukoplakia from perineal vitiligo are as follows:

Symptoms and signs

The main symptoms of vulvar leukoplakia are severe vulvar itching, sometimes with burning and pain, rough skin and lichenified thickening in the affected area, with scratches, chapped skin, local hypopigmentation, and general whitening of the labia majora and labia minora.

Vitiligo is painless and itchy. The surface of the vulva skin is smooth and moisturized, with normal texture and clear boundaries with adjacent skin. The white areas vary in size and shape.

Onset site

Vulvar leukoplakia mainly occurs in the vaginal mucosa, inner and outer sides of the labia minora, and clitoris, and then extends to the inner side of the labia majora and other parts.

The site of onset of vitiligo is irregular. On the vulva, it often occurs in the labia majora, labia minora, posterior clitoral symphysis, perineum, inner thighs, etc. It can also occur anywhere on the body, often in a symmetrical distribution.

Histopathological changes

Patients with vulvar leukoplakia have thickening of the granular layer of the skin in the affected area, irregular hypertrophy of the spinous layer with anaplasia and dyskeratosis, liquefaction of the basal layer with irregular cell arrangement, degeneration of the connective tissue in the upper dermis, diffuse infiltration of lymphocytes and plasma cells, and reduced areas of elastic fiber infiltration.

In patients with perineal vitiligo, the granular layer and spinous layer of the affected area are normal, the melanocytes in the basal layer are reduced or disappeared, the elastic fibers are normal, and there is generally no inflammatory infiltration.