Childhood Vulvar Lichen Sclerosus: The Course After Puberty

This article reports a series of 21 girls with childhood vulvar lichen sclerosus who have been followed through puberty. The patients attend a specialized pediatric vulvar clinic at the authors' institution. For the purposes of comparison, 263 women, including 12 young adult women and 251 postmenopausal women who attend the adult vulvar clinic for treatment of lichen sclerosus, were interviewed to determine the frequency of a history of childhood onset of symptoms. Among the 21 postpubertal girls, 16 reported an improvement of their condition after menarche, and 5 said they noticed no improvement. However, 11 of the 16 did report that they still had some symptoms, including pruritus severe enough to require occasional treatment with topical steroids. On physical examination, no visible disease was seen in five patients. Sixteen patients were found to have some persistent indications of disease, including pallor, atrophy, labial resorption, and/or purpura, although the severity of these signs had diminished. There were no apparent problems with menarche, coitus, pregnancy, delivery, or dysuria. Among the 12 young adult women interviewed, 4 had vulvar symptoms that started in childhood. One of these patients, who was first seen with advanced vulvar squamous cell carcinoma, had been treated for childhood vulvar lichen sclerosus, but her symptoms had apparently resolved at puberty. She died of disease at age 32. In the group of 251 postmenopausal women with vulvar lichen sclerosus, five could recall childhood symptoms.