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Table G-1. 2006 ISSVD classification of vulvar dermatoses: pathologic subsets and their clinical correlates (Table modified from the original)
Name of finding
Definition
Common clinical correlates
Vesiculobullous pattern
Immune deposits in skin may be bands of IgG or IgA at the basement membrane zone, of IgG deposits on the cell surface of keratinocytes.
Bullous pemphigoid, Cicatricial pemphigoid, Pemphigoid gestationis, Pemphigus vulgaris, Pemphigo vegetans
Spongiosis
Intercellular edema between keratinocytes in the epidermis; keratinocytes may become elongated; often accompanied by exocytosis of lymphocytes and sometimes neutrophils or eosinophils.
Eczematous dermatitis (atopic, contact and allergic)
Lichenoid pattern
A band-like infiltrate of inflammatory cells (usually lymphocytes) in the superficial dermis, parallel to the epidermis.
Lichen sclerosus, Lichen planus
Granulomatous pattern
Granulomas are conglomerates of monocyte-derived histiocytes (macrophages); sometimes mixed with other inflammatory cells.
Groups of these histiocytes may aggregate to form mulinucleated giant cells.
Chronic granulomatous diseases are a genetically heterogeneous group of immunodeficiencies producing infectious and non-infectious disease in which phagocytic cells fail to kill organisms that they have engulfed because of defects in a system of enzymes that produce free radicals and other toxic small molecules.
Crohn disease, Melkersson-Rosenthal syndrome
Dermal sclerosis
Increased collagen with decreased numbers of fibroblasts causing thickening.
Lichen sclerosus
Acanthosis
Diffuse epidermal hyperplasia with increased thickness of the stratum spinosum.
Lichen simplex chronicus, Psoriasis, Reiter’s syndrome
Acantholytic pattern
Loss of cohesion between keratinocytes because of dissolution of intercellular connections; may cause an intraepithelial vesicle. Keratinocytes are rounded rather than elongated and lymphocytes do not migrate into the epidermis.
Hailey-Hailey disease, Darier/s disease, Acantholytic dermatosis of the vulvocrural area
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