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Pediatric Lichen Sclerosus and Non-Accidental Trauma: A Systematic Review of Distinguishing Features and
Bianca Te1, Drue Julien1, Kristie Mar1
1Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Lichen sclerosus (LS) in children can mimic non-accidental trauma (NAT), leading to potential misdiagnosis of sexual abuse. This review highlights key differences to help clinicians accurately diagnose LS and avoid distressing outcomes for families.
Area of Science:
- Dermatology
- Pediatrics
- Forensic Medicine
Background:
- Lichen sclerosus (LS) is a chronic autoimmune skin condition affecting the anogenital area.
- LS in pediatric patients can be misdiagnosed as non-accidental trauma (NAT), specifically sexual abuse.
- Misdiagnosis can cause significant distress to families.
Purpose of the Study:
- To systematically review pediatric patients investigated for both LS and NAT.
- To provide clinical guidance for differentiating LS from sexual abuse in children.
- To reduce misdiagnoses and associated family distress.
Main Methods:
- Systematic review of MEDLINE, Embase, and Web of Science databases.
- Inclusion of retrospective studies, case series, and case reports.
- Descriptive statistical analysis due to data heterogeneity.
Main Results:
- 25 studies with 146 pediatric patients were included; all were investigated for sexual abuse.
- Lichen sclerosus (LS) was the final diagnosis in 89% of cases.
- Distinguishing features included patient behavior, family environment, and specific anogenital findings.
Conclusions:
- Lichen sclerosus (LS) and sexual abuse can coexist in pediatric patients.
- Thorough assessment of behavior, environment, and physical findings is essential for accurate diagnosis.
- Limitations include small sample sizes and lack of statistical comparisons.
Background/Objectives:
Lichen sclerosus (LS) is a chronic autoimmune inflammatory skin disease predominantly affecting the anogenital area that can be mistaken for non-accidental trauma (NAT) in pediatric patients, such as sexual abuse. Such misdiagnoses can be distressing for families. This systematic review examined pediatric patients investigated for both LS and NAT to provide clinicians with guidance on distinguishing these conditions.
Methods:
MEDLINE, Embase, and Web of Science were searched. Retrospective studies, case series, and case reports describing pediatric patients investigated for both LS and NAT were included. Descriptive statistics were used to analyze data due to heterogeneity in study designs and reporting.
Results:
Of 113 studies identified, 25 studies encompassing 146 patients were included. The suspected NAT was sexual abuse in all cases (N = 146). The final diagnosis was LS in 130 patients (89.0%), and LS and sexual abuse in 16 patients (11.0%). Patients who experienced sexual abuse often had known offenders in their families (n = 6/13) and displayed withdrawn or hypersexualized behavior (n = 2/13, unreported in n = 3/16), while those without abuse exhibited age-appropriate behavior (n = 8/41) and denied sexual abuse (n = 6/41) and demonstrated positive interactions with caregivers (n = 4/41, unreported in n = 89). On exam, hymenal disruption or scarring (n = 8/13) was more common in abused patients, whereas those without abuse typically lacked trauma to the hymen (n = 27/41) or anus (n = 10/41).
Conclusions:
LS and sexual abuse may co-occur. Careful assessment of patient behaviors, home environment, and anogenital findings is crucial to avoid misdiagnoses that may be distressing for families. Limitations include small sample size, and lack of statistical comparisons.
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