How to differentiate vulvar leukoplakia from lichen planus

Vulvar leukoplakia and lichen planus have similarities to a certain extent, and they must be carefully differentiated during clinical diagnosis to prevent misdiagnosis and delay the best early treatment opportunity for the disease.

1. Identification based on the site of disease onset

Vulvar leukoplakia mainly occurs in the vaginal mucosa, inner or outer sides of the labia minora, clitoris, inner sides of the labia majora, etc., while lichen planus mostly occurs in the vaginal vestibule or labia minora, and is often accompanied by oral and skin rashes, which are generally polymorphic, flat white papules that can merge into white patches.

2. Identification based on tissue lesions

Vulvar leukoplakia is a lesion of the keratinous tissue, while lichen planus is a lesion of hyperkeratotic tissue.

3. Identify from the changes in the skin layers of the lesion

In patients with vulvar leukoplakia, the spinous layer of the skin at the lesion site has irregular hypertrophic skin processes, the basal layer may have punctate liquefaction and irregular arrangement, and the connective tissue in the upper dermis will degenerate.

The spinous layer of the skin at the lesion site of patients with lichen planus becomes irregularly thickened, the basal layer undergoes extensive liquefaction degeneration, and edema occurs in the connective tissue above the dermis.

4. Identification based on inflammatory infiltration

In patients with vulvar leukoplakia, lymphocytes and plasma cells in the upper dermis will diffusely infiltrate, and only the elastic fibers of the skin in the infiltrated area will be reduced. In patients with lichen planus, subepidermal lymphocytes will develop dense band-like infiltration and infectious inflammation in the lesions.