TOPLINE:

Girls diagnosed with prepubertal vulvar lichen sclerosus who adhered to topical corticosteroid treatment were significantly more likely to achieve remission and report better quality of life.

METHODOLOGY:

• Researchers conducted a retrospective and prospective cohort study of 68 pediatric patients diagnosed with vulvar lichen sclerosus premenarche (mean age at diagnosis, 7.5 years; range 3-12 years) at a private dermato-gynecology practice in Sydney, Australia, from 2003 to 2022.
• Patients had received a standard treatment protocol with a high-potency topical corticosteroid (clobetasol propionate, 0.05%-0.1%; betamethasone dipropionate, 0.05%) applied daily for 6-12 weeks, followed by a taper to maintenance therapy using a lower potency topical corticosteroid (methylprednisolone aceponate, 0.1%; hydrocortisone acetate, 1%).
• Treatment adherence was categorized as full, partial, or nonadherent. Responses were categorized as partial (improvement with residual symptoms on treatment), complete (no symptoms on treatment), remission (no symptoms off treatment), and recurrence (return of symptoms after remission).
• The mean follow-up duration of 12.8 years.

TAKEAWAY:

• All signs and symptoms were reduced at the last follow-up from baseline, except urinary tract infections, and 62% of patients achieved remission after puberty; 92.3% of treatment-adherent patients achieved remission compared with 56.6% of partially or nonadherent patients (adjusted odds ratio, 8.7; P = .05); the former were 9.2 times more likely to reach a remission than nonadherent patients.
• At follow-up, adherent patients had fewer vulvar structural abnormalities than nonadherent patients (63.3% vs 83.3%), which was not a significant difference. The most common structural abnormalities were clitoral phimosis (42.6%), diminutive labia minora (41.2%), clitoral adhesions (23.5%), and absent labia minora (20.6%).
• Vulvar quality of life index scores were significantly better among adherent patients than among partially or nonadherent patients (mean, 1.6 vs 5.2; P < .001).
• The age at diagnosis and symptom duration before diagnosis were not associated with treatment response or the likelihood of structural abnormalities.

IN PRACTICE:

The higher remission rate and reduced risk for vulvar structural changes and scarring among patients who adhered to treatment, the study authors wrote, “emphasizes the need for aggressive early management, optimal patient education to ensure understanding of the benefits of adherence, and long-term follow-up to ensure disease resolution, or ongoing management when required.”

SOURCE:

The study was co-led by Alexandra Savage, Drummoyne Dermatology, Drummoyne, Australia, and Vera Y. Miao, Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia, and was published online on October 13 in Pediatric Dermatology.

LIMITATIONS:

Study limitations were the small sample size and single-center design. Additionally, follow-up durations varied between patients, with some individuals not returning for evaluation.

DISCLOSURES:

The authors declared receiving no funding information and reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.