Summary
Definition
History and exam
Key diagnostic factors
- pruritus
- violaceous, flat-topped papules or plaques
- Wickham striae
- mucosal erosions and lacy white network
- scarring alopecia
- nail involvement
Other diagnostic factors
- dorsal pterygium
- history of hepatitis C (HCV)
Risk factors
- hepatitis C (in some patient populations)
- -308 G/A polymorphism in TNF-alpha gene
- hepatitis B vaccination
- influenza vaccination
- coronavirus disease 2019 (COVID-19) vaccination
- psychosocial stress
- oral allergens
- use of certain drugs
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- histopathology
- hepatitis C screen
- immunofluorescence
Treatment algorithm
cutaneous disease
scalp disease
oral disease
genital disease
nail disease
Contributors
Authors
Deepani Munidasa, MBBS, MD
Consultant Dermatologist
Department of Dermatology
Anuradhapura Teaching Hospital
Anuradhapura
Sri Lanka
Disclosures
DM declares that she has no competing interests.
Acknowledgements
Dr Deepani Munidasa would like to gratefully acknowledge Dr Susan Cooper, Dr Rebecca Dunn, Dr Julia S. Lehman, Dr Megha M. Tollefson, and Dr Lawrence E. Gibson, previous contributors to this topic.
Disclosures
SC is chair of the British Society for the Study of Vulval Disease and receives royalties for contributions to UpToDate. RD, JSL, MMT, and LEG declare that they have no competing interests.
Peer reviewers
Brian Swick, MD
Clinical Assistant Professor
University of Iowa College of Medicine
Iowa City
IA
Disclosures
BS declares that he has no competing interests.
David Cassarino, MD, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
University of California
Los Angeles
CA
Disclosures
DC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American College of Obstetricians and Gynecologists. Practice bulletin no. 224: diagnosis and management of vulvar skin disorders. Jul 2020 [internet publication].Full text Abstract
Edwards SK, Bates CM, Lewis F, et al. 2014 UK national guideline on the management of vulval conditions. Int J STD AIDS. 2015 Aug;26(9):611-24. Abstract
Ioannides D, Vakirlis E, Kemeny L, et al. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol. 2020 Jul;34(7):1403-14.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Lichen simplex chronicus
- Psoriasis
- Lichen planus pemphigoides
More DifferentialsGuidelines
- Diagnosis and management of vulvar skin disorders
- European S1 guidelines on the management of lichen planus
More Guidelines
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