Vulvar Lichenoid Dermatoses: Clinical Spectrum and Quality of Life Burden

Original Article : Clinical spectrum and quality of life burden of vulvar lichenoid dermatoses: a cross-sectional study of 1177 patients

What are the key takeaways of this article?

Vulvar lichenoid dermatoses are a group of chronic inflammatory conditions affecting the vulvar skin and mucosa. Vulvar lichen sclerosis (VLS), vulvar lichen simplex chronicus (VLSC), and erosive vulvar lichen planus (EVLP) are the most common types. These conditions are frequently misdiagnosed, and comparative studies between them remain limited in the literature. This retrospective cross-sectional study by Liu et al. sought to characterize the clinical differences among these three diseases and evaluate their impact on patients’ quality of life (QoL).

A total of 1,177 adult patients diagnosed with VLS (n=682), VLSC (n=429), or EVLP (n=66) at a single-center vulvar outpatient clinic between 2017 and 2025 were included. The vulva was divided into nine anatomical regions to identify predilection sites for each of these three conditions. Quality of life (QoL) was assessed using the Dermatology Life Quality Index (DLQI) and the Vulvar Quality of Life Index (VQLI), with higher scores indicating greater disease burden across domains such as symptoms, sexual function, and future health concerns.

Predilection sites differed across the three conditions. VLS most commonly involved the labia minora and interlabial sulci, VLSC predominantly affected the labia majora and interlabial sulci, and EVLP most frequently involved the labia minora and vaginal opening. Clinically, VLS typically appeared as white atrophic plaques, VLSC presented with red lichenification, and EVLP presented with erythema and erosion. These distinctions can aid in differential diagnosis, as a majority of vulvar lichenoid dermatoses are diagnosed clinically rather than histopathologically.

Using the DLQI, all three conditions showed at least a moderate impact on QoL, with EVLP carrying the greatest overall burden. Results were similar for the VQLI, with EVLP showing a moderate impact compared to VLS and VLSC, both of which demonstrated mild impact. The most affected domains for both VLS and VLSC were symptoms and future health concerns, whereas sexual function was most affected among patients with EVLP.

This study represents the largest retrospective analysis to date comparing the clinical spectrum and QoL burden of vulvar lichenoid dermatoses, highlighting that knowledge of each condition’s  characteristic predilection sites may help providers reach an accurate diagnosis and streamline treatment. Additionally, identifying the specific QoL domains most burdened by each disease allows providers to take a more tailored approach in patient care. For example, proactively addressing current or potential sexual health concerns in patients with EVLP can help reduce disease burden.

Publication Date: July 6, 2026

Reference:

Teng Liu, Yingzi Zhang, Kailv Sun, Yakun Shao, Kun Yang, Min Yang, Jianmin Chang, Clinical spectrum and quality of life burden of vulvar lichenoid dermatoses: a cross-sectional study of 1177 patients, Clinical and Experimental Dermatology, 2026;, llag103, https://doi-org.webproxy2.ouhsc.edu/10.1093/ced/llag103

Summary By: Saramarie Azzun