Prof. Gayle Fischer
Vulval lichen sclerosus (VLS) is uncommon in children and adolescents and can be highly impactful on the quality of life of the child and the family. The majority of cases of VLS encountered in adolescents began in childhood and have already been effectively managed by parents by the time puberty occurs. However puberty is a particularly challenging period as the child’s need for autonomy often results in rejection of parental involvement and refusal to continue medical examinations. As a result poor compliance and treatment failure can occur. Psychological problems around sexuality, body image and adoption of tampons at menarche are also common. These problems can spill over into young adulthood. The risk of not treating around puberty is disease progression with irreversible loss of vulval architecture. Although treatment of this condition with topical corticosteroid can normalise skin and prevent distortion and scarring clinicians also need to be aware of the psychological needs of these patients and the impact that a childhood marked by regular genital examinations and treatment can have. This study documents the issues found in adolescent girls who first presented with VLS as pre-pubertal children and suggestions for managing this unique group of young adults with VLS will be made.
Clinical Pearls from the Paediatric Rheumatology-Dermatology Clinic
A/Prof. Ruth Ann Vleugels