How to differentiate vulvar leukoplakia from vitiligo

Vulvar leukoplakia and vitiligo are similar 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, the inner or outer sides of the labia minora, the clitoris, the inner sides of the labia majora, etc.; while vitiligo generally has irregular onset sites and can appear anywhere on the body, and is often distributed symmetrically. If it appears in an external area, it can generally be seen in other parts of the body as well.

2. Identification based on tissue lesions

Vulvar leukoplakia is a lesion of the keratin layer; while vitiligo is a significant hyperkeratotic tissue lesion.

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

In patients with vulvar leukoplakia, the granular layer of the skin at the lesion site will be thickened, the spinous layer will have 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 granular layer and spinous layer of the skin at the lesion site of vitiligo patients are normal, while the melanocytes in the basal layer of the skin lesions are reduced or disappeared, and there is no edema in the connective tissue of the upper 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 skin elastic fibers in the infiltrated area will be reduced; while in patients with vitiligo, the lesions generally have no inflammatory infiltration, and the skin elastic fibers do not change.