Childhood vulvar lichen sclerosus: the consequences of diagnostic delay

Abstract

Objectives: This series of 12 cases intends to raise awareness to Lichen Sclerosus, by illustrating its main clinical characteristics and complications, and by highlighting the importance of its early diagnosis. Methods: All of the patients discussed were attended at the Institute of Gynecology of the Federal University of Rio de Janeiro (UFRJ, Rio de Janeiro, Brazil), after being referred from primary care family medicine facilities. Results: We present 12 cases. The mean ages at the beginning of symptoms and clinical diagnosis were 6 and 9.25 years, respectively. The mean delay for diagnosis was 3.2 years. Vulvar pruritus and hypochromic macules were the most common initial symptoms. Complications included the fusion of the labia minora and clitoris entrapment. Cases with an earlier diagnosis had better responses to treatment with ultra-potent corticosteroids such as Clobetasol propionate ointment 0.05%. Conclusion: Diagnostic delay of LS leads to its progression and long-term physical-psychological consequences. It must be remembered as a differential diagnosis of vulvar pruritus in childhood.