Clinical spectrum and quality of life burden of vulvar lichenoid dermatoses: a cross-sectional study of 1,177 patients

Abstract Background Vulvar lichen sclerosus (VLS), erosive vulvar lichen planus (EVLP), and vulvar lichen simplex chronicus (VLSC) are the most common vulvar lichenoid dermatoses. They are frequently misdiagnosed in clinical practice and comparative studies among them remain limited. Objectives To analyze the clinical characteristics and quality of life (QoL) burden among these three conditions, raising awareness on these distressing vulvar diseases. Methods This retrospective cross-sectional study analyzed clinical registration data of adult patients diagnosed with VLS, EVLP, or VLSC at a single-center vulvar outpatient department from 2017 to 2025. The vulva was divided into nine anatomical regions to identify predilection sites. QoL was evaluated using either the Dermatology Life Quality Index (DLQI) or Vulvar Quality of Life Index (VQLI). Statistical analyses were conducted using GraphPad Prism version 8.2.1. Results This study included a total of 1,177 patients, comprising 682 patients with VLS, 429 patients with VLSC, and 66 patients with EVLP. The predilection sites varied among three diseases: the labia minora along with interlabial sulcus in VLS; the labia majora along with interlabial sulcus in VLSC; the labia minora along with vaginal opening in EVLP. A total of 941 patients were assessed using the DLQI. The median DLQI scores were 6.0 for VLS, 7.0 for VLSC, and 7.0 for EVLP, indicating a moderate effect on QoL. The remaining 236 patients were evaluated using the VQLI. The median VQLI scores were 12.0 for VLS, 13.0 for VLSC (indicating a mild impact on QoL), and 19.0 for EVLP, reflecting a moderate impact. The most affected domains included symptoms, feelings and emotions, and future health concerns (VLS and VLSC) or sex function (EVLP). Conclusions Clinicians and patients should pay more attention to vulvar lichenoid dermatoses, especially EVLP. Early diagnosis and treatment to improve clinical symptoms and relieve discomfort is essential to enhance the QoL.