MUCOSAL LICHEN-SCLEROSUS LICHEN-PLANUS OVERLAP SYNDROMES

Lichen sclerosus and lichen planus affecting cutaneous sites are easil y distinguishable clinically. Clinical signs on mucosal sites, however , may not allow differentiation between these diseases, and reliance i s frequently placed on histopathological findings. We report a series of seven patients with clinical evidence of coexisting vulval lichen s clerosus and lichenoid oral lesions. All patients had vulval biopsies, and four had oral biopsies. Histology of all the vulval biopsy specim ens showed features consistent with lichen sclerosus. Two of these pat ients developed vulval intraepithelial neoplasia during the course of their disease, and one progressed to a well-differentiated squamous ca rcinoma. Histology of the oral lesions showed features that were predo minantly those of lichen planus. There are, however, few reports of hi stologically proven oral lichen sclerosus. Variations in histopatholog ical descriptions of lichen sclerosus, depending on duration of diseas e, have been reported, particularly with regard to the position of the inflammatory infiltrate in relation to the dermo-epidermal junction. We believe that these patients may have oral lichen sclerosus, or at t he very least make up a distinctive group who need to be identified an d followed up, as their risk of oral dysplasia is unknown.