Question 2: Based on the patient’s history and physical exam so far, select the top 3 diagnoses on your differential?
● Lichen sclerosus (LS)
● Lichen planus (LP)
● Lichenoid Drug Reaction
● Graft-versus-host disease (GVHD)
● Mucous membrane pemphigoid (MMP)
● Herpes Simplex Virus (HSV)
Explanation:
Other choices:
LS is an autoimmune, inflammatory skin disease which typically causes genital lesions and rarely affects other mucocutaneous sites. The typical clinical appearance of anogenital LS is atrophic, ivory-white epithelium which affects the vulvar region as well as the perianal skin. Erosions, ecchymosis, fissures may also be present. White lacy reticular patches in the buccal mucosa are not a common presentation of LS.
GVHD occurs when the transplant recipient recognizes immune cells from a non-identical donor as foreign, leading to an immune reaction in the recipient. Common skin manifestations in GVHD include erythema, maculopapular rash, and pruritus. Oral and genital lesions seen in GVHD are similar to those seen in LP.
HSV is a common cause of oral and genital lesions. HSV-1 is commonly associated with oral lesions, whereas HSV-2 is associated with genital lesions. They typically present as painful erosions and diagnosis is made with a viral swab for polymerase chain reaction test.