"Worse Than Disappointing": Prediagnostic Health Care Challenges of Women With Inflammatory Vulvar Dermatoses

TikTok as a Source of Education and Misinformation in Lichen Sclerosus

OBJECTIVES

The purpose of this study is to evaluate the content, delivery, and quality of medical information for vulvar lichen sclerosus on the social media platform TikTok.

MATERIALS AND METHODS

This is a descriptive, cross-sectional study. Using the third-party data scraping tool Apify, TikTok videos tagged with #lichensclerosus or "lichen sclerosus" were identified and sorted by view count. A sample of 100 videos was reviewed by 2 independent reviewers, excluding those not discussing lichen sclerosus. Videos were assessed using a coding document, the Patient Educational Materials Assessment Tool, and the DISCERN instrument. Interrater reliability was measured, and statistical analyses included Fleiss' kappa, intraclass correlation coefficient, t tests, and Wilcoxon rank sum test with Holm-Bonferroni correction.

RESULTS

Content creators included patients (46%), health care professionals (30%), and others. Topics focused on clinical disease (52%) and treatment (48%). Evidence-based medicine was discussed in 71.7% of treatment-related videos, while 51.7% included nonevidence-based approaches, with a neutral or positive sentiment. Videos discussing topical steroids often had negative sentiments. Quality assessment revealed 61% of videos were understandable, 27% actionable, and 46% contained misinformation. Videos by health care professionals had less misinformation and higher quality scores compared to patient-generated content. Commercially biased videos were more understandable but contained more misinformation.

CONCLUSIONS

TikTok serves as a significant platform for sharing information on lichen sclerosus, but nearly half of the content contains misinformation. Health care professionals need to engage in social media to provide accurate information and counteract misinformation. Enhanced collaboration with patient advocates and careful resource sharing can improve the quality and reliability of medical information available online.

Growing up with juvenile vulvar lichen sclerosus: the experiences and care needs of adult women with lichen sclerosus since childhood - a qualitative exploration

BACKGROUND

Vulvar lichen sclerosus (VLS) is a chronic remitting condition that affects the genital skin of females of all ages. Although qualitative studies have been conducted that have focused on women with VLS in mid-life or beyond, less is known about the experiences of individuals with VLS from childhood or adolescence onward.

OBJECTIVES

To gain an understanding of the experiences of women with a history of juvenile VLS (JVLS) with regard to the impact of the disease on their personal lives, and their experiences and needs regarding care and guidance.

METHODS

A qualitative study was conducted consisting of 27 in-depth face-to-face interviews with adult women with a histologically confirmed history of JVLS, striving for maximum variation and saturation. Interviews were audio recorded and transcribed verbatim. A thorough thematic content analysis was performed.

RESULTS

Three main themes were identified. Theme 1 was named 'Varying impact of living with JVLS': women experienced diverse emotional and physical impacts, from shame and denial to complete acceptance, from restrictions in daily functioning to no limitations; they felt hindered by their own lack of knowledge about JVLS and generally expressed positivity in sharing their experiences with people close to them. Theme 2 was entitled 'Finding one's way in care and guidance': while navigating care and guidance, women often felt hindered by knowledge gaps among healthcare professionals (HCPs), lack of continuity in care and guidance, lack of life phase-adjusted and future-oriented information provision, inadequate guidance around life events and insufficient monitoring of determinants of treatment adherence. Theme 3 was named 'Need for patient-tailored care involving appropriate and compassionate care and guidance': patients stressed the need for age-appropriate and life phase-adjusted information, guidance around life events and compassionate contact with knowledgeable HCPs aware of the determinants of treatment adherence and influencing factors.

CONCLUSIONS

Age-appropriate, life phase-adjusted, individually tailored care for women diagnosed with VLS in childhood or adolescence is needed. Care and guidance from childhood onward should encompass a standard of care adapted to the individual as their needs change over time. This involves taking interpersonal differences into account, including differences in support network and coping strategies. These findings demonstrate the need to improve awareness and knowledge about JVLS/VLS among HCPs, especially primary care providers, and among the general public.

Adverse healthcare experiences are correlated with increased time to diagnosis in women with vulvar inflammatory dermatoses: a retrospective cohort survey

This retrospective cohort survey of over 300 women examined diagnostic delay in vulvar dermatoses compared with nonvulvar control conditions (e.g. psoriasis or atopic dermatitis). Adverse healthcare experiences (e.g. uncertainty of which provider to consult, embarrassment in talking to providers) occurred more often for participants with vulvar disease and were significantly correlated with increased time to diagnosis in this group, which was not the case in control conditions. The findings suggest opportunities to improve care for people with vulvar disease.

Incidence of Vulvar Lichen Sclerosus and of Cancer Among Vulvar Lichen Sclerosus Patients: Does Socioeconomic Status Have a Role?

OBJECTIVE

Socioeconomic status (SES) impacts on the incidence of many inflammatory diseases and cancers, but there is no evidence on its implication in vulvar lichen sclerosus (VLS). The authors aimed to assess possible associations between SES and both occurrence of VLS and cancer occurrence among VLS patients.

MATERIALS AND METHODS

A retrospective cohort of women resident in the province of Ferrara, Italy, affected with VLS diagnosed between 2001 and 2020, was investigated for assessing any association of SES with VLS and cancer incidence. The SES was expressed through an ecological-based deprivation index identifying 5 subgroups.

RESULT

Four-hundred women were diagnosed with VLS during the study period, with double the number of cases in the second decade (2011-2020) compared with the first (2001-2010). More VLS patients belonged to the high rather than the low SES groups (p = .032). From VLS diagnosis to 2018 (1,958.4 total person*years at risk), 22 patients received their first diagnosis of cancer, mainly the skin, breast, and vulva. No significant differences in cancer incidence were found between high/medium-high and low/medium-low SES subjects.

CONCLUSIONS

The fact that more VLS patients belonged to the highest socioeconomic classes may be due to a more frequent diagnosis in those with greater health seeking behavior and resources. An involvement of SES-related factors in VLS pathophysiological background can also be taken into consideration. Both the lack of marked social and economic differences in the study area and the availability of free visits and screening may account for the lack of association between SES and cancer development.

Living with vulval lichen sclerosus: a qualitative interview study

BACKGROUND

Vulval lichen sclerosus (VLS) is a chronic inflammatory condition predominantly affecting the anogenital skin. Symptoms can be distressing and affect quality of life and everyday activities. Very little research has been undertaken to explore the experience of living with VLS from the perspective of people with the condition.

OBJECTIVES

To understand individuals' experiences of VLS and its impact on their lives.

PARTICIPANTS AND METHODS

Semi-structured remote (telephone or video) interviews were conducted with a purposive sample of 20 women living in the UK with VLS recruited via online support groups and social media. Data collection and analysis was informed by social constructionist grounded theory, using a constant comparison method.

RESULTS

We developed three themes to interpret the experience of living with VLS: missed opportunities (participants experienced delayed diagnosis, lack of information and disempowering encounters with healthcare professionals); learning to live with a long-term condition (the amount of work involved in learning how to self-manage the disease and the impact on everyday life); a secret life (experiences of the condition were often shrouded in secrecy, and there was stigma associated with a vulval skin condition resulting in them feeling isolated and lonely).

CONCLUSIONS

Patients attending healthcare appointments with vulval complaints should be examined and LS should be considered as a diagnosis. Healthcare professionals' awareness and knowledge of VLS needs to be improved and they should avoid language which is blaming or minimizing of patients' experiences. VLS is a chronic condition and patients need to be supported in self-management. Support groups may be a source of support and information but can also be challenging when hearing others' difficult experiences. Wider public health educational activities are needed to change societal attitudes towards female genitals and tackle the stigma around vulval conditions. What is already known about this topic? Vulval lichen sclerosus (VLS) can have a profound impact on quality of life and self-identity but is relatively underexplored from the perspective of those living with the condition. What does this study add? In-depth findings about the experiences of living with VLS including ongoing issues with timely diagnosis, learning to live with a long-term condition and the secrecy and stigma about the condition. The needs of women with symptoms of and diagnoses of VLS are not being met sufficiently by the healthcare system. What are the clinical implications of this work? Healthcare professionals should consider addressing knowledge gaps in vulval conditions including VLS to prevent delayed diagnosis and avoid the use of certain terminology which can minimize patients' experiences. Patients with vulval complaints should be examined and LS should be considered as a diagnosis. Regular follow-up would reflect its chronic nature and could provide patients with reassurance and confidence in self-management. Wider public health activities are needed to change societal attitudes and tackle stigma around vulval conditions.

Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses

Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September-November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19-81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.