11. Lichen Sclerosus Throughout Childhood and Adolescence: Not Only a Premenarchal Disease

Background Vulvar lichen sclerosus is a benign dermatologic condition marked by inflammation and epithelial thinning. It is thought to mostly occur in low estrogen states, though a few studies have shown that symptoms may persist following puberty. The purpose of this study is to characterize a cohort of pediatric and adolescent females with lichen sclerosus and compare age of symptom onset, documented symptoms and duration, and exam findings. Methods This is an IRB exempt retrospective cohort study of females aged 0-21 years seen between 2000 and 2020 with the diagnosis of lichen sclerosus by ICD-9 or 10 code. Study variables included age at symptom onset, age at diagnosis, presenting symptoms, exam findings, and presence of symptoms before and after menarche. Groups were compared using the chi square test of independence and Fisher's exact test. Data were analyzed using SPSS Version 27. Results One hundred patients met inclusion criteria. Forty patients noted presence of symptoms following menarche; 26 (65%) reported first symptom onset after age 13, while 14 (35%) had symptoms that started in childhood and persisted after menarche. Eleven patients with childhood onset of symptoms had no documented report of symptoms following menarche. Of the remaining 49 patients, 25 are still under age 13 and 24 were lost to follow-up. After excluding the 7 patients with reported childhood onset of symptoms that were not seen until adolescence, the patients with onset of symptoms at age 13 or older (n=26) were less likely to present with vaginal bleeding (3.8% vs 25.4%, p=0.02), dysuria (15.4% vs 32.8%, p=0.09), and constipation or painful defecation (0% vs 14.9%, p=0.05) than the younger cohort (n=67). Vulvar itching (61.5% vs 71.6%) and pain (38.5% vs 44.8%) were similar in both groups. Seven patients (26.9%), ranging in age from 17-21 years, presented with dyspareunia. On initial physical exam, the patients with symptom onset at age 13 or older were more likely to have clitoral adhesions (19.2% vs 3%, p=0.02), loss of labia minora (38.5% vs 3.0%, p Conclusions This study suggests that lichen sclerosus can present or persist after menarche in at least 40% of patients. It can cause architectural vulvar changes that interfere with sexual function, which may be the presenting complaint. It is important for providers to consider lichen sclerosus as a new diagnosis in both pre and postmenarchal patients as well as monitor for progression of disease throughout the pubertal transition and adolescence.