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A Longitudinal Multiinstitutional Study of Vulvar Lichen Sclerosus: From Childhood to Perimenopause

Jacopo Di Giuseppe1, Giovanni Delli Carpini1, Luca Giannella1

  • 1Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy.

Journal of Lower Genital Tract Disease
|April 25, 2024
PubMed

Insights

Vulvar lichen sclerosus (VLS) presents differently in premenarchal and postmenarchal individuals, with younger patients experiencing more bleeding and specific skin involvements. Early recognition of these distinct clinical signs is crucial for timely diagnosis and management of VLS.

Area of Science:

  • Dermatology
  • Gynecology
  • Pediatric Gynecology

Background:

  • Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis affecting the vulva.
  • It can lead to significant morbidity, impacting sexual function and quality of life, even in premenopausal individuals.
  • VLS is often misdiagnosed in younger populations, leading to delayed treatment.

Purpose of the Study:

  • To evaluate clinical characteristics, comorbidities, and treatments in patients with VLS from childhood to perimenopause.
  • To compare these characteristics based on menarchal status (premenarchal vs. postmenarchal).

Main Methods:

  • Retrospective longitudinal study of 186 patients diagnosed with VLS between January 2002 and June 2022.
  • Inclusion criteria: patients under 45 years old across 10 referral centers.
  • Univariate analysis was used to compare variables based on menarchal status.

Main Results:

  • Premenarchal patients showed a higher incidence of subepithelial hemorrhage signs, including bleeding, easy bruising, fissures, and petechiae/splinter hemorrhages.
  • The perineum and perianal region were significantly more involved in the premenarchal group.
  • Topical calcineurin inhibitors were more frequently used in premenarchal patients, while vitamin E oil and moisturizers were more common in postmenarchal patients.

Conclusions:

  • VLS exhibits distinct clinical manifestations in premenarchal versus postmenarchal individuals.
  • Recognizing these differences can aid in earlier diagnosis and management of VLS.
  • VLS requires prompt diagnosis and treatment to mitigate long-term morbidity and improve quality of life.
Abstract

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