A Histologic Review of Vulvar Inflammatory Dermatoses and Intraepithelial Neoplasm

Patients with urogenital complaints are frequently encountered by family practitioners, gynecologists, and dermatologists. This review article provides practical information regarding normal anatomy and embryology of the vulva, followed by a summary of procedural techniques. The new classifications of vulvar inflammatory and intraepithelial neoplasm proposed by the ISSVD are used as guidelines to review the wide spectrum of diseases involving this organ.

Currently, urogenital complaints are among the most common problems encountered by family practitioners, gynecologists, and dermatologists. When a patient suffering from a vulvar disorder presents to the health care system, there are 3 elements to be considered: (1) the patient’s sociocultural background that affects how she perceives the disease often leading to delay in seeking care or self-treatment, (2) the clinical presentation of the disease, and (3) the clinical setting of this evaluation, as there is not a single medical specialist trained to care for the spectrum of diseases occurring in this anatomic location.

In response to the intricacy of vulvar disorders, the International Society for the Study of Vulvovaginal Disease (ISSVD) was created to facilitate the exchange between clinicians and pathologists involved in the care of these patients. Often, the “diagnosis” on a biopsy result is not the name of a disease, but rather a description of the microscopic findings. For the average clinician, this is sometimes unhelpful. In an attempt to allow the clinician to benefit from a nondiagnostic biopsy, the ISSVD recently developed a histologic classification of inflammatory vulvar disorders that allows for the generation of a differential diagnosis based on microscopic findings ( Table 1 ). This can be extremely useful when correlated with a clinical differential diagnosis. The ISSVD has also proposed a clinically relevant histologic classification for vulvar intraepithelial neoplasia (VIN) ( Table 2 ).

Table 1

Modified version of the 2006 ISSVD classification of vulvar dermatoses: pathologic subsets and their clinical correlates

Spongiotic pattern	Eczematous dermatitis (atopic, contact, and allergic)
Acanthotic pattern	Lichen simplex chronicus (primary and secondary)
	Psoriasis
	Reiter’s syndrome
Lichenoid pattern	Lichen sclerosus
Lichenoid pattern	Lichen planus
Dermal sclerosis pattern	Lichen sclerosus
Vesiculobullous pattern	Bullous pemphigoid
	Cicatricial pemphigoid
	Pemphigoid gestationis
	Pemphigus vulgaris
	Pemphigo vegetans
Acantholytic pattern	Hailey-Hailey disease
	Darier’s disease
	Acantholytic dermatosis of the vulvocrural area
Granulomatous pattern	Crohn’s disease
Granulomatous pattern	Melkersson-Rosenthal syndrome
Vasculopathic pattern	Aphthous ulcers
	Behcet’s disease
	Plasma cell vulvitis

Data from Lynch PJ. 2006 International Society for the Study of Vulvovaginal Disease classification of vulvar dermatoses: a synopsis. J Low Genit Tract Dis 2007;11(1):1–2; and Lynch PJ, Moyal-Barracco M, Bogliatto F, et al. 2006 ISSVD classification of vulvar dermatoses: pathologic subsets and their clinical correlates. J Reprod Med 2007;52(1):3–9,110.

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