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Lichen Sclerosus throughout Childhood and Adolescence: Not Only a Premenarchal Disease

Published:August 28, 2022DOI:https://doi.org/10.1016/j.jpag.2022.08.011

      ABSTRACT

      Study Objective

      To determine the frequency of persistence of vulvar lichen sclerosus (LS) through the pubertal transition and assess if the symptomatology and exam findings differ by menarchal status at onset of symptoms

      Design

      A retrospective cohort study

      Setting

      Academic tertiary care hospital

      Participants

      Females aged 21 years or younger with a diagnosis of vulvar LS

      Intervention

      None

      Main Outcome Measures

      Menarchal status at symptom onset, presenting symptoms, exam findings, persistence after menarche

      Results and Conclusions

      Of the 196 patients who met criteria, 141 were premenarchal and 55 postmenarchal. Of these 55, 36 had postmenarchal symptom onset, and the others had premenarchal symptom onset or LS diagnosis. Over the data review period, 26 patients were followed through the pubertal transition, and 10 (38.5%) had continued symptoms of LS. The premenarchal group (n = 141) was significantly more likely than the symptom-onset postmenarchal group (n = 36) to present with vulvar itching (70.2% vs 52.8%; P = .048), vulvar bleeding (26.2% vs 5.6%; P = .008), and bowel symptoms (16.3% vs 0%; P = .009). The premenarchal group was significantly more likely on exam to have subepithelial hemorrhages (24.8% vs 5.6%; P = .01). The postmenarchal group had more clitoral adhesions (25.0% vs 4.3%; P < .0001) and loss of labia minora (47.2% vs 2.1%; P < .0001). Thirteen postmenarchal patients presented with dyspareunia. This study suggests that premenarchal LS can persist after menarche in about 40% of adolescents and can initially develop in postmenarchal adolescents. Initial symptoms and exam findings differ on the basis of menarchal status. Continued surveillance is recommended.

      Key Words

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