The full text of this article hosted at iucr.org is unavailable due to technical difficulties.

Childhood Onset Vulvar Lichen Sclerosus Does Not Resolve at Puberty: A Prospective Case Series

Saxon D. Smith M.B.Ch.B.

Dermatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia

Search for more papers by this author
Gayle Fischer F.A.C.D.

Dermatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia

University of Sydney, New South Wales, Australia

Search for more papers by this author
First published: 21 December 2009
Cited by: 25
Address correspondence to Saxon D. Smith, M.B.Ch.B., M.H.L., Dermatology Department, Level 11, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia, or e‐mail: saxon.smith@dr.nswama.com.au.

Dr. Saxon D. Smith and Dr. Gayle Fischer equally contributed to the construction of this review article and case series.

Abstract

Abstract: When vulvar lichen sclerosus occurs in prepubertal children it is widely believed that it is likely to remit at puberty. However when it occurs in adult women it is accepted that remission is unlikely and that in addition untreated or inadequately treated disease may be complicated by significant disturbance of vulvar architecture and less commonly squamous cell carcinoma. Our database reveals 18 girls who developed lichen sclerosus prior to puberty who are now adolescents or young adults. Twelve have remained under surveillance and the other six patients have been lost to follow‐up. We report a prospective series of these 12 patients. Three patients have achieved complete remission sustained for three or more years, all prior to menarche. Nine patients, or 75% of the cohort, who still had active lichen sclerosus at puberty continue to require maintenance therapy after menarche. Of the 12, six have had significant disturbance of vulvar architecture. The concept that prepubertal lichen sclerosus resolves at puberty would appear not to be true in the majority of patients. Even when diagnosed early and treated effectively, childhood onset lichen sclerosus may be complicated by distortion of vulvar architecture.

Number of times cited: 25

  • , Skin diseases of the vulva: inflammatory, erosive-ulcerating and apocrine gland diseases, zinc and vitamin deficiency, vulvodynia and vestibulodynia, Journal of Obstetrics and Gynaecology, 10.1080/01443615.2017.1328590, 38, 2, (149-160), (2017).
  • , Cushing Syndrome Induced by Topical Corticosteroids for the Treatment of Lichen Sclerosus, Journal of Pediatric and Adolescent Gynecology, 10.1016/j.jpag.2018.09.004, (2018).
  • , The treatment of vulval lichen sclerosus in prepubertal girls: a critically appraised topic, British Journal of Dermatology, 176, 2, (307-316), (2017).
  • , Epidemiology of Vulvar Pain, Vulvar Pain, 10.1007/978-3-319-42677-8_2, (9-18), (2017).
  • , Autoimmune Dermatoses, Practical Immunodermatology, 10.1007/978-94-024-0902-4_13, (297-340), (2016).
  • , Vulvar Pain in Childhood: A Call for a More Accurate Diagnosis and Care, Vulvar Pain, 10.1007/978-3-319-42677-8_4, (53-70), (2017).
  • , Lichenoid vulvar disease: A review, International Journal of Women's Dermatology, 10.1016/j.ijwd.2017.02.017, 3, 1, (58-64), (2017).
  • , Genital lichen sclerosus in childhood and adolescence—a retrospective case series of 15 patients: early diagnosis is crucial to avoid long-term sequelae, European Journal of Pediatrics, 10.1007/s00431-017-3004-y, 176, 10, (1429-1432), (2017).
  • , Dermatoses of the Female Genitalia, Rook's Textbook of Dermatology, Ninth Edition, (1-52), (2016).
  • , A retrospective analysis of pediatric patients with lichen sclerosus treated with a standard protocol of class I topical corticosteroid and topical calcineurin inhibitor, Journal of Dermatological Treatment, 27, 1, (64), (2016).
  • , Treatment of vulvar lichen sclerosus with topical corticosteroids in children: a study of 72 children, Clinical and Experimental Dermatology, 40, 3, (289-292), (2014).
  • , Prepubertal‐Onset Vulvar Lichen Sclerosus: The Importance of Maintenance Therapy in Long‐Term Outcomes, Pediatric Dermatology, 32, 4, (461-467), (2015).
  • , Lichen Sclerosus and Lichen Planus in Women and Girls, Clinical Obstetrics and Gynecology, 58, 1, (125), (2015).
  • , Clinical Recommendation: Pediatric Lichen Sclerosus, Journal of Pediatric and Adolescent Gynecology, 27, 2, (111), (2014).
  • , Diagnosis and Treatment of Lichen Sclerosus, American Journal of Clinical Dermatology, 14, 1, (27), (2013).
  • , Low-concentration Topical Tacrolimus for the Treatment of Anogenital Lichen Sclerosus in Childhood: Maintenance Treatment to Reduce Recurrence, Journal of Pediatric and Adolescent Gynecology, 26, 4, (239), (2013).
  • , The Course of Lichen Sclerosus Diagnosed Prior to Puberty, Journal of Pediatric and Adolescent Gynecology, 26, 3, (153), (2013).
  • , Lichen sclerosus of the vulva, Expert Review of Obstetrics & Gynecology, 8, 1, (57), (2013).
  • , Lichen sclerosus in children and adolescents, Current Opinion in Obstetrics and Gynecology, 25, 5, (370), (2013).
  • , Clinical Scoring System for Vulvar Lichen Sclerosus, The Journal of Sexual Medicine, 9, 9, (2342-2350), (2012).
  • , Screening and follow up of vulval skin disorders, Best Practice & Research Clinical Obstetrics & Gynaecology, 26, 2, (175), (2012).
  • , Dermatologie, Pédiatrie, 10.1016/B978-2-294-71375-0.50012-X, (227-281), (2011).
  • , Lichen sclerosus et atrophicus, Monatsschrift Kinderheilkunde, 159, 5, (468), (2011).
  • , Quoi de neuf en dermatologie pédiatrique en 2010 ?, Annales de Dermatologie et de Vénéréologie, 137, (S145), (2010).
  • , Paediatric vulval lichen sclerosus, Australasian Journal of Dermatology, 50, 4, (243-248), (2009).