Pediatric Vulvar lichen sclerosus may persist even after menarche

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition affecting the anogenital region, which is commonly seen in a prepubertal or adolescent patient. The most popular theories are its autoimmune and genetic conditioning, although theories concerning hormonal and infectious etiology have also been raised.

Though there is lack of evidence for the rates of remission and progression of the disease, it is generally now acknowledged that pediatric vulvar lichen sclerosus (pVLS) can persist beyond puberty. Recent studies reveal that this condition may persist in as many as 75% of cases. The most common presenting symptoms of VLS is vulva pruritus, discomfort, dysuria and constipation.

Dr Veronica Boero MD, PhD and team made an effort to answer to the most common query that is how does pVLS evolve after menarche? The findings are published in Pediatric Dermatology journal.

The researchers in the current retrospective study of 31 patients with pediatric vulvar lichen sclerosus, found that 58% of the patients were still affected by vulvar lichen sclerosus, 26% were asymptomatic with persistent clinical signs of the disease, and 16% had complete remission after a follow up of 14 years.

The study was a observational retrospective study conducted on premenarchal girls diagnosed with pVLS in their institution between 1990 and 2011 describes 31 patients who returned for multidisciplinary clinical evaluation following menarche.

The findings of the study are

• The mean follow-up time was 14 years. At the post-menarche clinical examination, patients were classified as follows: 58% were still affected by Vulvar lichen sclerosus.

• 16% presented with a complete remission of disease, and 26% were completely asymptomatic although with persistent clinical signs of Vulvar lichen sclerosus.

The researchers concluded that “In our series, pVLS persists following menarche in the majority of patients. These findings suggest the importance of a long-term follow-up even among patients who report resolution of symptoms following menarche.”

They added that patients and parents should be counseled that most pediatric patients with vulvar lichen sclerosus have a persistence of their condition after menarche and that long-term follow-up is required.

Reference: Veronica Boero MD, PhD, Riccardo Cavalli MD et al ; Pediatric vulvar lichen sclerosus: Does it resolve or does it persist after menarche?; 30 March 2023, DOI:https://doi.org/10.1111/pde.15308