Lichen sclerosus et atrophicus in children misdiagnosed as sexual abuse

Lichen sclerosus et atrophicus and sexual abuse

AIMS

The aetiology of lichen sclerosus et atrophicus (LSA) is unknown. A series of 42 cases of this uncommon condition is reported. The aim of this study was to identify associations of LSA and document the association with sexual abuse.

METHODS

Information about the patients was obtained by retrospective case note review and some patients were contacted by telephone for further information.

RESULTS

In 12 cases there was evidence of sexual abuse. The abused group were slightly older than the non-abused group but were similar in all other respects. All three patients who presented over the age of 12 years had evidence of sexual abuse. Genital trauma was recalled by the patient or found at examination in 17 cases. Evidence of autoimmunity was present in five cases. Positive microbiological isolates were obtained in 18 cases. In only 11 cases were there no associated factors. The symptoms of LSA started between the ages of 3 and 7 years in most patients. The usual symptoms were related to genital skin involvement, and symptoms related to bladder and bowel function were common (50%).

CONCLUSION

In this large series of paediatric LSA, associations with trauma, autoimmunity, and infection were noted. There was a high rate of coexisting sexual abuse with LSA, possibly due to genital trauma.

Lichen sclerosus

Lichen sclerosus, usually appearing in the dermatologic literature under the names of lichen sclerosus et atrophicus, balanitis xerotica obliterans, and kraurosis vulvae, is an inflammatory disease with a multifactorial origin. A past association of lichen sclerosus and genital squamous cell carcinoma is not as close as once thought. Once considered primarily a surgical problem, especially when the genitals were involved, lichen sclerosus will respond to a variety of systemic and topical therapies.

Familial lichen sclerosus et atrophicus in childhood

Lichen sclerosus et atrophicus (LSA) is uncommonly reported in family members and is seen occasionally in young children. We report genital LSA in two young sisters who were diagnosed a year apart. The English language literature on familial LSA in childhood is reviewed and discussed.

Penile purpura as a manifestation of lichen sclerosus et atrophicus

Heightened public and professional awareness of the sexual abuse of children demands that physicians be able to distinguish lesions associated with sexual abuse from those caused by primary skin disorders. Purpura is an occasional manifestation of pediatric lichen sclerosus et atrophicus (LSA), especially when the vulva is affected. We report a 12-year-old boy with penile purpura that occasioned a consideration of sexual abuse but proved to be due to LSA.

Lichen sclerosus et atrophicus--a review of 15 cases in young girls

We report a series of 15 girls who developed lichen sclerosus between the ages of 18 months and 9 years. Only five of these were initially referred to a dermatologist and the diagnosis was made promptly in these cases on the first visit to the clinic. The diagnosis was usually delayed under disciplines less familiar with the disease. We encountered a high level of parental anxiety regarding the possibility of misdiagnosis of lichen sclerosus as childhood sexual abuse. Dysuria and pain on defaecation were common and prominent symptoms which have not previously been stressed adequately. The clinical features were diagnostic in all our cases, although three had undergone vulval biopsy under general anaesthesia prior to being seen by a dermatologist. There was a trend towards improvement with increasing age.

Lichen sclerosus

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