Childhood Onset Vulvar Lichen Sclerosus Does Not Resolve at Puberty: A Prospective Case Series

TLDR

Vulvar lichen sclerosus in prepubertal children is commonly thought to remit at puberty, whereas in adult women remission is unlikely and untreated disease can lead to architectural distortion and, rarely, squamous cell carcinoma. This study prospectively reports on 12 girls with childhood‑onset lichen sclerosus followed into adolescence. The authors identified 18 prepubertal cases in their database, of which 12 were retained for surveillance and 6 were lost to follow‑up. Among the 12 prospectively followed patients, only three achieved sustained remission before menarche, while nine (75 %) remained active at puberty and required ongoing therapy, and six experienced significant vulvar architectural distortion, indicating that childhood onset lichen sclerosus rarely resolves at puberty even with early treatment.

Abstract

Abstract: When vulvar lichen sclerosus occurs in prepubertal children it is widely believed that it is likely to remit at puberty. However when it occurs in adult women it is accepted that remission is unlikely and that in addition untreated or inadequately treated disease may be complicated by significant disturbance of vulvar architecture and less commonly squamous cell carcinoma. Our database reveals 18 girls who developed lichen sclerosus prior to puberty who are now adolescents or young adults. Twelve have remained under surveillance and the other six patients have been lost to follow‐up. We report a prospective series of these 12 patients. Three patients have achieved complete remission sustained for three or more years, all prior to menarche. Nine patients, or 75% of the cohort, who still had active lichen sclerosus at puberty continue to require maintenance therapy after menarche. Of the 12, six have had significant disturbance of vulvar architecture. The concept that prepubertal lichen sclerosus resolves at puberty would appear not to be true in the majority of patients. Even when diagnosed early and treated effectively, childhood onset lichen sclerosus may be complicated by distortion of vulvar architecture.