Summary
Definition
History and exam
Key diagnostic factors
- pruritus
- violaceous, flat-topped papules or plaques
- Wickham's 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 investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- histopathology
- hepatitis C (HCV) 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.
Differentials
- Lichen simplex chronicus
- Psoriasis
- Lichen planus pemphigoides
More DifferentialsGuidelines
- 2021 European guideline for the management of vulval conditions
- British Association of Dermatologists and British Photodermatology Group guidelines for narrowband ultraviolet B phototherapy
More Guidelines
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