Vulvar lichen sclerosus in children: A prospective study over a 3 year period

Context: Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease affecting prepubertal girls and postmenopausal women. In prepubertal girls, it causes anxiety in parents and affects quality of life considerably. There is a paucity of data about VLS in children from India. Aims: We aimed to study the demographic and clinical profile of VLS in children. Settings and Design: It is a prospective study over a period of 3 years from October 2017 to September 2020. Materials and Methods: All the children up to the age of 15 years with VLS, attending to our outpatient department between October 2017 and September 2019, were enrolled in the study after taking informed consent from the parents/guardian. The age, duration, clinical features, and comorbidities were noted. Biopsy was done only in clinically doubtful cases. All the cases were treated with topical clobetasol 0.05% ointment once daily for 3 months, and tacrolimus 0.03% or pimecrolimus 1% ointment was given as maintenance therapy. Cases were followed up for a period of 6 months–3 years. Results: Twenty-five girls presented with VLS during the study period. The mean age was 8.44 years, and the mean duration at presentation was 1.14 years. Pruritus was present in 14 (56%); constipation and dysuria were noted in 2 each. Classical figure-of-eight appearance was observed in only 4 cases; atrophy and erythema were noted in 11 cases and 3 cases, respectively. All symptoms improved in 3–4 weeks after treatment and depigmentation completely subsided in 8 cases by 3 months. Limitations: The diagnosis of VLS was made clinically in most cases. Dermoscopy was not done. Biopsy was done in only clinically doubtful cases. Conclusions: VLS in children needs special attention as it causes anxiety in parents thinking it as vitiligo. Pruritus is the common symptom. Ultrapotent topical steroid helps in the management. It may not resolve completely at puberty