ABSTRACT
BACKGROUND: Many case studies of lichen sclerosus (LS) have reported an association of vitiligo. However, such an association is not reported from larger case studies of vitiligo, which happens to be a common disease. Autoimmune etiology suspected in both LS and vitiligo has been considered as the reason for their association in some patients. It has also been suggested that lichenoid inflammation in LS may trigger an autoimmune reaction against melanocytes. AIMS: To test this association, we reviewed clinical and histological features of 266 cases of vitiligo and 74 cases of LS in a concurrent study of both diseases. METHODS: All outpatients seen in our department between 2003 and 2006 and who were diagnosed as having LS or vitiligo on the basis of clinical and pathologic features were included in the study. RESULTS: Vitiligoid lesions were seen along with stereotypical LS lesions in three patients but all the three lesions had histological features of LS. Oral/genital areas were affected in 57 out of the 74 LS cases and of those, 15 were initially suspected to have vitiligo. These cases with a clinical appearance of vitiligo and histological features of LS were considered as 'vitiligoid LS', a superficial variant proposed by J. M. Borda in 1968. Association of LS was not observed in the 266 cases of vitiligo. CONCLUSION: Exclusive oral/genital depigmentation is a common problem and histological evaluation is essential to differentiate vitiligoid LS from true vitiligo. The association of vitiligo with LS may have been documented due to the clinical misdiagnosis of vitiligoid LS lesions as vitiligo as histological investigations were not undertaken in any of the reported cases.
Subject(s)
Humans , Lichen Sclerosus et Atrophicus/classification , Vitiligo/classificationABSTRACT
El liquen escleroso puede ser encontrado en cualquier grupo etáreo, sexo o raza. En la literatura se ha descrito varias formas deliquen escleroso. Objetivo: Facilitar el estudio de liquen escleroso, sistematizando sus caracteres clínicos. Materiales y métodos: Ensayar una clasificación sobre formas clínicas de liquen escleroso, de acuerdo a su frecuencia y la consistencia de cómo son definidos en la literatura médica. Resultados: Entre enero a noviembre de 2006, en 1417 pacientes encontramos 8 diferentes formasclínicas. Formas clásicas: en reloj de arena o forma de 8 (1 forma), balanitis xerótica obliterante (1), pequeñas placas en el pene (3) -relacionado a circuncisión previa por fimosis (2) -. Formas no clásicas: generalizada (1 forma), asociado a carcinoma escamoso de vulva (1), concomitante a hemorragia uterina disfuncional (1), superpuesta a morfea y dermatitis infectiva en una paciente infectada con el HTLV-I (1). Conclusiones: Las 8 diferentes formas de liquen escleroso encontradas en este trabajo sugieren la necesidad de continuar buscando una clasificación que permita un adecuado reconocimiento de estas diferentes formas.
Lichen sclerosus can be found at any age, sex or race. Several clinical forms of lichen sclerosus have been described in the literature. Objective: To facilitate lichen sclerosus study organizing its clinical features. Materials and methods: A classification of the clinical forms of lichen sclerosus was assayed. Clinical features were organized according to frequency and consistency as defined in medical references. Results: Between January and November 2006, we found 11 cases of lichen sclerosus in 1417 dermatology patients. Eight different clinic forms were found. Classical forms: æfigure of eightÆ shape (1 form),balanitis xerotica obliterans (1), small plaques in penis (3) related to previous circumcision for phimosis (2). Non-classical forms: generalized (1 form), associated to vulvar squamous carcinoma (1), concomitant to morphoea and dysfunctional uterine bleeding (1) and superimposed to morphoea and infective dermatitis in an HTLV-I infected patient (1). Conclusions: The finding of eight different forms of lichen sclerosus suggests the need to continue looking for an ideal classification to adequately recognize these different clinical forms.