Hyperplastic Vulvar Dystrophy (Squamous Cell Hyperplasia, Lichen Simplex Chronicus)

Introduction

• Description: Hypertrophic vulvar dystrophy (lichen simplex chronicus) is a thickening of the vulvar skin over the labia majora, outer aspects of the labia minora, and clitoral areas. Eczematous inflammation or hyperkeratosis may be present.

• Prevalence: Common, 40%–45% of non-neoplastic epithelial disorders.

• Predominant Age: Middle to late reproductive age and older.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Unknown. Dermal reaction to chronic itch-scratch cycle. Often associated with or worsened by stress and can be seen as a localized variant of atopic dermatitis. It represents an end-stage response to a wide variety of possible initiating processes, including environmental factors and dermatologic disease.

• Risk Factors: Genital atrophy (postmenopausal), recurrent vulvitis.

Signs and Symptoms

• Vulvar itching (almost always present)

• Dusky-red to thickened-white appearance of the vulva

• Fissuring and excoriations (common)

Diagnostic Approach