Clinical symptoms:
(1) genital or perineal itching/pruritis which can be intense
(2) genital or perineal irritation or soreness
(3) bleeding without antecedent history of trauma
(4) painful defecation
(5) dysuria
Findings on clinical examination:
(1) Lesions may be limited to the labia or extend in an hour-glass configuration around the introital and perianal area. They tend to be bilateral and symmetrical.
(2) Lesions may appear inflamed, as whitish papules or plaques or a thinned and parchment-like.
(3) Subepithelial hemorrhage, purpura, ecchymoses, telangiectasia or hematomas may be present.
(4) genital ulceration and/or fissures
(5) agglutination of labia majora with labia minora
(6) phimosis of the clitoral hood
(7) contraction of the introitus with stenosis
(8) perinanal fissures, strictures, ulcerations and/or stenosis
(9) Lesions may develop in extragenital sites.
(10) There is sparing of the vaginal mucosa.
Biopsy:
(1) mild to moderate patchy chronic inflammation of the dermis which tends to decrease as fibrosis progresses
(2) progressive dense fibrosis with thinning of the epidermis, loss of the rete ridges and flattening of the basal layer, hyperkeratosis and reduced vascularity
Course: The condition is chronic and often lasts for many years. Some cases resolve with the onset of puberty while others persist into adulthood.
Differential diagnosis:
(1) sexual abuse
(2) contact dermatitis.
