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Research Letter
Feb 2012

Lichen Sclerosus Exhibiting Histologic Signs of Lymphedema: An Essential Factor in the Pathogenesis of Verruciform Xanthoma —Reply

Author Affiliations

Author Affiliations: Departments of Dermatology (Drs Fite and Moyal-Barracco) and Pathology (Dr Plantier), Assistance Publique des H ôpitaux de Paris (APHP), Hospital Cochin, Paris Descartes University, Paris, France.

Arch Dermatol. 2012;148(2):260-262. doi:10.1001/archdermatol.2011.2085

In reply

We appreciate the interest of Carlson et al in our article on vulvar VX1 as well as their comment about the possible etiologic roles of lymphostasis and HPV. Our 10 vulvar VX cases were all associated with another vulvar condition, mainly LS but also lichen planus (2 cases), vulvar radiodermatitis (1 case), and Paget disease (1 case). Our findings sustain the hypothesis of Zegarelli et al2 that damage to the epithelium —particularly of the DEJ, in our opinion, could trigger the following cascade: (1) entrapment of epithelial cells in the papillary dermis; (2) subsequent degeneration of these cells and lipid formation; (3) engulfment of released lipids by macrophages; and (4) accumulation of foam cells between the rete ridges.