Ultrapotent Topical Corticosteroid Treatment of Childhood Genital Lichen Sclerosus

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Abstract
LICHEN SCLEROSUS is a chronic skin disorder of unknown cause that most commonly occurs in adult women. However, 10% to 15% of cases arise during childhood,1 and almost always affect the genital area. Only 6% of pediatric patients with lichen sclerosus have extragenital involvement.2 The disease occurs much more frequently in girls than in boys, with a reported female-male ratio as high as 10:1.2-4 The associated symptoms, particularly pruritus, pain, dysuria, and constipation with pain on defecation, may be chronic and are often disruptive. Because of the location of lesions, discomfort, and signs of localized purpura with bleeding and discoloration, lichen sclerosus in children may be misdiagnosed as child abuse or as a genital infection. The course in children is variable, with some experiencing spontaneous remission, while others show persistence of signs and symptoms in adulthood. However, most reports suggest that affected patients improve significantly at puberty. Earlier studies2,5 noted remission of the lichen sclerosus in 80% of patients by puberty. Others6,7 have described persistent evidence of the disorder (pallor, atrophy, or loss of tissue) in 89% to 97% of patients, but resolution of symptoms in most patients.

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