Tests
1st tests to order
clinical diagnosis
Test
No tests are usually necessary. Characteristic history and exam findings are usually sufficient to diagnose the condition.
Result
features of LS
Tests to consider
skin biopsy
Test
Diagnosis is often made based on clinical findings.
Indications for biopsy include:[35][56][61]
Concern for malignancy
Failure of initial treatment
Diagnostic uncertainty
Atypical cases.
Note that biopsy samples are generally not taken from children with suspected LS; however, refer children who do not respond to initial therapy or in whom there is diagnostic doubt for specialist input and consideration of biopsy (i.e., to a pediatric dermatologist or pediatric gynecologist with expertise in vulval disorders).[7][56]
Immunohistochemistry with CD34 may be useful for differentiating LS from other lichenoid dermatitides such as lichen planus.[62][63]
One small study of 5 patients with confirmed LS found that CD34 expression was absent from areas of affected visible collagen in LS samples.[62]
Result
findings may include: atrophic epidermic with effaced rete edges, dense lymphocytic band of cells in the dermis +/- collagen homogenization, vacuolar interface dermatitis, and pigment incontinence; CD34 expression absent in areas of affected visible collagen
Emerging tests
optical coherence tomography (OCT)
Test
OCT is a noninvasive imaging technique that may have future utility in diagnosis of LS alongside dermatoscopy.
One small observational study that included 25 women, 10 of whom had LS, used a combination of OCT and dermatoscopy to define characteristics to aid differentiation of affected skin from healthy vulvar skin, which could complement clinical assessment.[64]
Further studies on utility and applicability of this technique are warranted.
Result
sclerotic areas and arborizing vessels
high-frequency ultrasound
Test
High-frequency ultrasound is a noninvasive imaging technique that may have utility in diagnosis of LS, but is not currently standard of care.
One high-frequency study of lesions from 40 patients with confirmed LS found that a hypoechoic dermal band was present in all lesions, with a significant linear positive correlation between the histopathologic depth and corresponding hypoechoic dermal band thickness. The authors concluded that high-frequency ultrasound characteristics may provide valuable information in the precise diagnosis and the treatment monitoring of vulval LS.[66]
Further studies on the utility and applicability of this technique are warranted.
Result
hypoechoic dermal band in LS lesions
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