The demise of "dystrophy": A history of the evolving terminology

Historically, both gynecologists and dermatologists were involved in the diagnosis and treatment of vulvar disorders. Gynecologists generally cared for disorders that were believed to be malignant or premalignant and dermatologists mostly cared for disorders that were believed to be benign. There was, however, appreciable overlap with both specialties caring for a large group of lesions, often white in color, that were termed kraurosis vulvae or leukoplakia by gynecologists and lichen sclerosus or lichen simplex chronicus by dermatologists. Gynecologists believed that these were premalignant and tended to excise them; dermatologists believed they were benign and treated them medically. This confusion in terminology and treatment remained troublesome until 1960 when Jeffcoate (7) followed a group of such patients and found that the outcome was essentially benign. Shortly thereafter he suggested that a more neutral term, "dystrophy", be applied to these lesions with the implication that, in most instances, surgical excision was not necessary. The term dystrophy initially had great appeal and it became widely used. In 1975, the International Society for the Study of Vulvar Disease (ISSVD) included dystrophy in a published classification of vulvar disease but, due to the influence of dermatologists and pathologists in the society, separated out the readily recognizable condition, lichen sclerosus, from the category of dystrophies. As dermatologists and gynecologists worked more closely with each other it became apparent that other vulvar dystrophies were also distinctive enough to be separately identified. Recognizing this fact, the ISSVD, in 1987, published a revised classification of vulvar disorders that deleted the term "dystrophy" and substituted the terms "squamous cell hyperplasia", "lichen sclerosus" and "other vulvar dermatoses". Since then the term "dystrophy" has mostly disappeared from use with fewer than 10 manuscripts containing that term having appeared in the PubMed database in the last five years.