Vestibular Sclerosis: Is This a New, Distinct Clinicopathological Entity?

OBJECTIVES: The aims of this case series were to present a series of patients with clinical and histopathological findings consistent with a recently described condition vestibular sclerosis (VS) and to contribute to the current discussion of whether VS is a subset of lichen sclerosus (LS) or a distinct entity.

MATERIALS AND METHODS: This case series of 6 women for a 12-month period was initiated from an ongoing collaboration between a gynecological dermatologist and an anatomical pathologist specializing in gynecological dermatopathology.

RESULTS: We describe 6 women with white, hyperkeratotic patches and plaques confined to the vulvar vestibule with stromal sclerosis and an absence of inflammation on histology. All our patients were either perimenopausal or postmenopausal. The condition was either asymptomatic or characterized by mild to moderate dyspareunia. No patient had LS elsewhere on the vulva. There was no response to estrogen or topical corticosteroid therapy in symptomatic patients.

CONCLUSIONS: Vestibular sclerosis may be a new distinct clinicopathologial entity, which is in the differential diagnosis of white plaques and patches in the vulvar vestibule. The characteristic siting in the anterior vestibule only, in the presence of an otherwise normal vulva and absence of inflammation on histology, is a reason to separate this condition from LS.