White plaques on the vulva

Clinical findings A 59-year-old woman presented with an 18-month history of raised areas on her vulva causing itching and soreness. These had begun to cause discomfort during sexual intercourse. Her medical history included chronic plaque psoriasis treated effectively with ustekinumab and chronic cutaneous lupus erythematosus (CCLE). Her CCLE presented with discoid lesions affecting her back, and follicular plugs and scattered superficial plaques with associated scalp alopecia (Figure 1). She used lymecycline and tacrolimus ointment to manage her scalp CCLE. Physical examination revealed two scaly, white plaques, 6 mm in size, located on both labia minora and a thickened area on the left interlabial sulcus (Figure 2). Clobetasol ointment (Dermovate; GlaxoSmithKline, Brentford, Middlesex, UK) was prescribed for 8 weeks, leading to a reduction in the size and discomfort of the lesions. The patient continued to use this ointment as required to control her symptoms. Histopathological findings A 4-mm punch biopsy was taken from the right plaque. Histology of the vulval biopsy showed an interface reaction, hydropic degeneration of the basal layer with apoptotic keratinocytes and pigment incontinence and thickening of the epidermal and follicular basement membrane (Figure 3). There was a lymphohistiocytic infiltrate in the superficial dermis. There was no dysplasia. Periodic acid–Schiff stain was negative for fungal organisms.

Citation

Wainman, H. E., McSwiney, N. T., Barfoot, M., Craig, P. J., & Davies, E. E. G. (2023). White plaques on the vulva. Clinical and experimental dermatology, 48(2), 152–154. https://doi.org/10.1093/ced/llac063

DOI

10.1093/ced/llac063

URI

https://hdl.handle.net/20.500.14709/423