Oral Lichen Planus and Vulvar Lichen Planus Association
Yes, if you have lichen planus in the mouth (oral lichen planus), it is definitely possible to have vulvar lichen planus as well. This coexistence is well-documented in medical literature, with some patients experiencing involvement of both oral and genital mucosa simultaneously or sequentially 1.
Evidence for Coexistence
- A 2023 study identified 86 women who had both oral lichen planus (OLP) and vulvar lichen sclerosus (LS), demonstrating that mucosal inflammatory conditions can affect multiple sites 1.
- The vulvovaginal-gingival syndrome is a recognized variant of mucosal lichen planus characterized by erosions and desquamation affecting the vulva, vagina, and gingiva simultaneously 2.
- In 50% of cases, oral lichen planus is diagnosed before vulvar involvement, suggesting a potential progression pattern 1.
Clinical Presentation
- Oral lichen planus typically presents as white, reticulated lesions or erosive/ulcerative lesions on the gingiva and other oral mucosal surfaces 2.
- Vulvar lichen planus often manifests as erosive lesions similar to those seen in the mouth 2.
- The onset of erosive or ulcerative mouth lesions may precede or follow vulvovaginal lesions by months or even years 3.
Diagnostic Considerations
- When lichen planus is identified in one mucosal site, clinicians should examine other potential sites of involvement 4.
- Biopsy may be necessary to confirm the diagnosis, as clinical signs on mucosal sites sometimes do not allow differentiation between lichen planus and other conditions like lichen sclerosus 5.
- Some patients may have overlap syndromes with features of both lichen planus and lichen sclerosus affecting different mucosal surfaces 5.
Treatment Implications
- Topical corticosteroids are the most frequently used treatment for both oral and vulvar lichen planus 1.
- More severe cases may require systemic therapies such as oral corticosteroids, azathioprine, hydroxychloroquine, or other immunomodulatory medications 3.
- Concomitant use of several drugs is usually required to achieve beneficial results in patients with multi-site involvement 2.
Risk of Malignancy
- While vulvar lichen planus carries a small risk of progression to squamous cell carcinoma (SCC), a study of patients with both oral and vulvar involvement found vulvar SCC in only 2.3% of patients 1.
- No cases of oral SCC were reported in patients with both conditions in the same study 1.
- Regular follow-up is essential as patients with chronic erosive and atrophic lesions may be at increased risk for malignant transformation 4.
Clinical Recommendations
- If you have oral lichen planus, a complete examination of genital mucosa should be performed to identify potential vulvar involvement 4.
- Early management and careful follow-up are important to prevent complications such as dyspareunia (painful intercourse) in cases of vulvar involvement 4.
- Treatment should address all affected sites simultaneously for optimal disease control 2.
The term "plurimucosal lichen planus" has been proposed to describe this condition affecting multiple mucosal sites, recognizing that the disease can manifest beyond just the vulvovaginal-gingival areas 4.