PS2.049Vulvar lichen sclerosus - an unusual cause of vulvar pruritus

Author(s): 
Carla Sofia Costa, R Carvalho-Ferreira, E Fernandes
USF Santa Maria, Tomar, Portugal
Corresponding author: Dr Carla Sofia Costa, USF Santa Maria,  Medicina Geral e Familiar, Tomar, Portugal.
E-mail: carla_sofia_costa@hotmail.com
Text: 
Background: Vaginal pruritus is one of the most frequent symptoms reported by female patients. Although the majority of cases have an infectious aetiology, there are other less common causes such as allergic reactions, dermatological conditions or autoimmune disorders.
Case Report: Woman of 57 years old that came to a family planning visit for cervical cancer screening, referring intense vaginal pruritus, dyspareunia and pelvic discomfort for several years with repercussions in her professional and family life. She was treated with fluconazole 150 mg PO and sertoconazole 2g/100mg cream in the past without symptomatic relief.
The vulvar examination revealed erythema with hypopigmentated areas, fusion of small and large vaginal lips, itchy lesions and hyperkeratotic plaques.
It was admitted the presumptive diagnosis of vulvar lichen sclerosus and the patient was referred to Dermatology, where she was submitted to a vulvar biopsy which confirmed the diagnosis.
Discussion: Lichen sclerosus (LS) is a chronic inflammatory skin disease that mainly affects the anogenital region with higher incidence in females, and typically with a peak of onset in prepubertal and peri or postmenopausal women. The aetiology remains unknown but it is thought that genetic factors may be involved as well as local, hormonal and immunologic abnormalities or autoimmune diseases.
Vulvar LS confers an increased risk for squamous cell cancer of the vulva development, therefore its essential an early detection, treatment and excision of hyperkeratotic areas resistant to treatment.
This case report illustrates the need of being aware of other less frequent causes of vaginal pruritus that may conceal potentially severe diseases, highlighting the importance of family physicians that are in a privileged position for the diagnosis and referral of these cases.