Líquen escleroso e atrófico em criança com história de abuso sexual: relato de caso

JUSTIFICATIVA E OBJETIVOS: O liquen escleroso e atrofico (LEA) e doenca inflamatoria cronica, caracterizada por maculase papulas branco-nacaradas com espiculas corneas, que podem confluir formando areas homogeneas de hipopigmentacao. Sua etiologia e desconhecida, porem ha evidencias de que esta seja multifatorial com base autoimune. Foram descritos como fatores desencadeantes: infeccoes genitais previas, alteracoes hormonais e trauma local. Pode acometer todas as faixas etarias de ambos os sexos, sendo dez vezes mais comum no sexo feminino. O objetivo deste estudo foi apresentar caso de LEA em paciente pre-pubere com historia de possivel abuso sexual. RELATO DO CASO: Paciente do sexo feminino, 10 anos, branca, sem comorbidades, foi referenciada ao servico de dermatologia do Hospital Naval Marcilio Dias para avaliacao de lesao branco-nacarada, assintomatica na regiao genital. A responsavel pela menor relatou que havia observado a lesao ha sete dias. Referia historia de abuso sexual em investigacao, ha oito meses. Ausencia de historia pessoal e familiar de doenca autoimune. Ao exame dermatologico: placas hipocromico-atroficas, assintomaticas, de superficie apergaminhada, bem delimitadas, simetricas, localizadas nos grandes labios. CONCLUSAO: O LEA e doenca inflamatoria cronica, mais comum em nossa pratica do que previamente reportado, cuja etiologia e desconhecida. Existem estudos que comprovam a associacao entre LEA e o trauma. Seu reconhecimento nos estagios iniciais permite o tratamento precoce evitando evolucao para craurose vulvar na mulher e balanite xerotica obliterante no homem, sendo estas, lesoes pre-malignas. O LEA e um exemplo de afeccao dermatologica que necessita de abordagem multidisciplinar. As lesoes genitais em pacientes jovens devem ser avaliadas por urologistas, pediatras, cirurgioes gerais, ginecologistas, alem dos dermatologistas... BACKGROUND AND OBJECTIVES: Lichen sclerosous etatrophicus (LSA) is a chronic inflammatory disease characterized by pearly white macules and papules with horny spicules which can coalesce to form homogeneous areas of hypopigmentation.Its etiology is unknown, but there is evidence that it is multifactorial with an autoimmune basis. Triggering factors were described: hormonal changes, local trauma, and previous genitalin fections. LSA can affect all age groups and both genders, but its incidence is ten times higher in female than in male patients. The purpose of this study is to report a case of LSA in a prepubertal patient with history of possible sexual abuse. CASE REPORT: Female patient, ten years old, white, no comorbidities,was sent to the dermatology department of Hospital Naval Marcilio Dias for evaluation of ivory-white asymptomatic lesion located in genital area. The person responsible for the minor patient reported that the lesion was observed seven days before. There was referred history of sexual abuse under investigation,eight months before. There is no personal or family history of autoimmune disease. At dermatological examination: asymptomatic, parchment-like surface, well-defined, symmetrical, hypochromicatrophic plaques located in the labia majora. CONCLUSION: Lichen sclerosous et atrophicus (LSA) is a chronic inflammatory disease, more common in our practice than previously reported, whose etiology is unknown. There are studies showing the association between LSA and trauma. Its recognitionin the first stages allows an early treatment avoiding the progression to kraurosis vulvae in women, and balanitis xerotic aobliterans in men, which represent premalignant lesions. The LSA is an example of a dermatological condition that requires multidisciplinary approach. Along with the dermatologist examination,genital lesions in young patients should be evaluated by urologists, pediatricians, general surgeons, and gynecologists...