Paediatric and adolescent vulvar lichen sclerosus: delay in diagnosis

Vulvar Lichen Sclerosus(VLS) is an uncommon, often misdiagnosed condition with a chronic course. Children presenting with VLS may have a wide variety of complaints, which complicates diagnosis. The differentiation of symptoms in the course of VLS causes great diagnostic difficulties. Delayed diagnosis may have an impact on vulvar architecture and long-term sexual health, and can often lead to frustration for both the patient and her parents. The aim of this study was to determine the reasons for delayed diagnosis of VLS in girls and adolescents and to investigate the number of different doctors and specialists consulted before the diagnosis of VLS, the symptoms reported, and the clinical presentation at time of diagnosis. We conducted a retrospective descriptive unicentric cohort study by reviewing medical charts of paediatric and adolescent girls diagnosed with VLS in a tertiary Swiss Centre. The average delay from first symptoms to VLS diagnosis was three years. Many symptoms went unrecognised despite consultations with a wide range of specialists. Once topical corticosteroids were prescribed, relief of symptoms was very quick, usually within one month. Conclusion: Even for a wealthy country such as Switzerland, with ample access to healthcare and specialists, it still takes a long time to arrive at the correct diagnosis and treatment of VLS. Improving knowledge and understanding of VLS disease among paediatricians and healthcare providers could lead to earlier diagnosis and treatment, and thereby significantly improve patient outcomes. (Table presented.)