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Vulvar lichen sclerosus (LS) affects 1 in 1000 women and has no cure. Early treatment decreases the chances of scarring and reabsorption of the normal anatomy and is therefore important. In some LS, subepidermal sclerosis is absent, presenting as a dermatitis difficult to distinguish from other disease. These authors examined histologic findings in LS, seeking features that would promote early diagnosis.
They looked for 28 criteria in 100 LS biopsies of genital and perianal skin (55, marked sclerosis; 16, mild sclerosis; 29 without sclerosis). Sclerosis was found in 59% of consecutive LS biopsies. In all nonsclerotic LS samples, thickening of individual collagen fibers with lymphocytes aligned in rows between fibers was seen. Many samples (5…