Vulvar Lichen Planus (VLP) is a chronic inflammatory skin condition that specifically affects the vulva, the external female genital area. This article describes its common visual presentations.
The Hallmarks of Its Appearance
Vulvar Lichen Planus can manifest in various visual forms. The most commonly recognized presentation is the erosive type, which often appears as raw, red, and moist areas on the vulvar skin. These areas represent a loss of the superficial skin layers.
The color of VLP lesions can vary, ranging from bright red to darker reddish-brown or purplish hues. Some forms of VLP can also present as small, shiny, purple bumps or papules.
VLP can lead to the formation of firm white papules or plaques. These thickened areas may have irregular borders and a rough, scaly texture, sometimes resembling wart-like growths.
While erosions may feel raw and appear moist, other areas might be smooth and shiny. In advanced cases, the skin may lose its normal structure, becoming thin and fragile, or conversely, developing thickened and hyperkeratotic patches.
Specific Patterns and Locations
VLP often displays characteristic patterns. A distinguishing feature is fine, white, lacy lines, known as Wickham’s striae, which can be seen on the surface of lesions or around their borders. These delicate, web-like patterns may appear on the vulva or at the edges of red, eroded patches.
The lesions can also form in linear or fern-like patterns, reflecting how the condition might spread or appear in response to minor skin trauma. Beyond these specific patterns, the overall affected area might appear as well-demarcated patches with a distinct hyperkeratotic (thickened) white border.
VLP frequently affects specific anatomical sites within the vulvar region. The labia minora, the inner folds of the vulva, are commonly involved, as is the vestibule, the area around the vaginal opening. The erosive form often begins in the posterior vestibule and can extend forward to the labia minora.
Other common locations include the labia majora, the larger outer folds, and the clitoral hood. The perineum, the area between the vulva and the anus, and even the perianal region can also be affected. While the appearance can be consistent across these areas, the moist environment of the inner vulva might emphasize the raw, eroded nature of the lesions.
Accompanying Physical Sensations
While the visual appearance of Vulvar Lichen Planus is a primary concern, the condition is frequently accompanied by a range of physical sensations. Intense itching (pruritus) is a common symptom.
Many individuals experience a burning sensation in the affected vulvar area. This burning can be persistent and contribute significantly to daily distress. Pain is another frequently reported sensation, often described as soreness or rawness, especially in areas with erosions or open sores.
Discomfort during sexual activity, known as dyspareunia, is a prevalent symptom, particularly when lesions are present in the vaginal opening or within the vagina itself. This pain can be exacerbated by the friction and pressure of intercourse, sometimes leading to bleeding after sex.
The pain associated with VLP can also extend to urination, causing a stinging or burning sensation (dysuria). In some cases, there may be an abnormal vaginal discharge, which can be purulent, malodorous, or even blood-tinged, further contributing to discomfort. Long-standing inflammation can lead to scarring, which may result in anatomical changes such as the fusion of the labia minora or narrowing of the vaginal opening, intensifying pain and making activities like sexual intercourse more challenging.