Clinical and Demographic Characteristics of Pediatric Lichen Sclerosus: A Retrospective Study

OBJECTIVE Pediatric vulvar lichen sclerosus (VLS) is an inflammatory dermatosis that often presents with pruritus, dysuria, and constipation and can lead to long-term sequelae including scarring. Epidemiologic and clinical data in diverse US pediatric populations are limited. We aimed to characterize demographic and clinical features of pediatric VLS in a large health maintenance organization. METHODS Retrospective cohort study of female patients aged 0 to 18 years diagnosed with VLS in Kaiser Permanente Southern California from 2009 to 2019. Inclusion required at least 2 International Classification of Diseases, Ninth/Tenth Revision codes for LS diagnosis codes within 6 months, with at least 1 in-person evaluation. Electronic medical record review of 167 patients confirmed diagnoses, demographics, presenting and diagnosing specialties, differential diagnoses, examination findings, and biopsy rates. RESULTS VLS was identified in 167 patients, predominantly in prepubertal girls (7.3 ± 3.6 years) with broad ethnic representation (Hispanic, 46.1%, white, 28.7%). VLS was associated with autoimmune comorbidities including vitiligo, scleroderma, and systemic lupus erythematosus. Pediatricians and dermatologists diagnosed LS nearly equally. Biopsy confirmation rate was 6%. Common differential diagnoses were candidiasis and vitiligo; nonaccidental trauma was considered in 17 patients and was associated with delayed diagnosis and management. CONCLUSION These data provide a comprehensive profile of pediatric VLS in a large US health system and highlight age patterns, racial and ethnic distributions, complex clinical presentations, and common differential diagnoses that lead to diagnostic delays. These findings support heightened clinical awareness, early recognition, and multidisciplinary management in diverse pediatric populations.