Pediatric emergency medicine trisk 2160 2160

Patients may present with vaginal bleeding or concern for trauma.
Lichen sclerosis will cause permanent scarring and sexual dysfunction
if untreated.

LICHEN SCLEROSIS
Lichen sclerosis is an uncommon, inflammatory, chronic skin disorder that most
often affects the vulva. It is thought to be an autoimmune disorder. In this
condition, lesions are white, flat-topped papules, plaques, or atrophic patches
involving the vulvar and perianal skin in a “figure 8” pattern around the vulvar
and perianal areas. The involved area is usually well demarcated. Purpura is a
hallmark finding when there is vulvar involvement. Patients may present with
vulvar pruritus, pain, dysuria, or bleeding from the affected tissue. Findings may
also be misinterpreted as trauma causing parents to bring their child in for
concern of possible sexual abuse.
Diagnosis in children can usually be made by visual inspection. In addition to
the white, “figure 8” appearance of the affected skin, ecchymoses,
fissures/erosions, and telangiectasias are frequently present ( Fig. 92.5 ). Lichen
sclerosis does not affect the vaginal mucosa.
Lichen sclerosis can lead to loss of the normal labia and architecture of the
vulva causing long-term sexual dysfunction if not treated. Therefore, goals of
treatment are proper identification and initiation of treatment to prevent long-term
effects. Treatment is with topical, high-potency corticosteroids (clobetasol 0.05%
ointment) applied to the affected area twice daily for 2 weeks. Patients should be
reexamined at 2 weeks to assess for response. Patients usually require 6 to 12
weeks of treatment with topical steroids until symptoms and visible findings have
resolved. After this point, the topical steroid should be tapered to avoid rebound
that can be seen with abrupt cessation. Immunomodulators are an alternative to
topical steroids. The disorder has a waxing and waning course, with many
patients experiencing frequent recurrences. For the majority of patients, the
disorder resolves after menarche; however, a small proportion of patients may
have persistent disease.