To the Editor: Lichen sclerosus (LS) is a chronic, inflammatory disorder that may lead to anogenital malignancy and scarring. 1,2 The pathophysiology is poorly understood; although autoantibodies targeting extracellular matrix 1 protein and the basement membrane zone have been identified, experts favor a T-cellemediated pathogenesis. 1,2 Small studies show an association with thyroid disorders, vitiligo, and psoriasis. [1][2][3] Increased risk of vulvar squamous cell carcinoma is also reported, with a lifetime incidence of 0.4% to 6% in women with LS. 4 We sought to determine the prevalence of these commonly cited comorbidities in the largest cohort of women with LS to date.The study population included patients in the IBM MarketScan Databases from 2015 to 2017 with 2 or more independent diagnoses of LS (International Classification of Diseases, 10th RevisioneClinical Modification L90.0). This database comprises more than 21.7 million commercially insured women in the United States. The study population was compared to a control group of women without LS. Stata statistical analysis software version 15.0 (StataCorp, College Station, TX) was used to examine the prevalences of Hashimoto disease/chronic lymphocytic thyroiditis/autoimmune thyroiditis, Graves disease/thyrotoxicosis, vitiligo, psoriasis, and vulvar carcinoma. Odds ratios and 95% confidence intervals were calculated. A P value of \.05 was considered significant.We identified 10,004 women with LS and 21,672,016 female control individuals without LS from 2015 to 2017 in the United States. The mean age was 50.8 years; 79% were between 45 and 65 years old. The rates of comorbid conditions are shown in Table I. In the LS population, the prevalences were as follows: autoimmune thyroid diseases, 6.11%; vitiligo, 1.95%; psoriasis, 5.12%; and vulvar carcinoma, 1.9%. All comorbidities were more likely to occur in patients with LS compared to control individuals (Table II). The most commonly associated autoimmune disease was hypothyroidism, with a prevalence of 4.26%. Notably, vulvar carcinoma was 26 times more likely and vitiligo was 12 times more likely to occur in patients with LS.We identified only 4 studies that examined the rates of similar comorbidities in LS. [1][2][3]5 One comparing 50 patients with LS to 50 control individuals cited an autoimmune disease prevalence This project was accomplished through a generous gift from The Louis and Rachel Rudin Foundation, Inc, which supports the research education of residents at New York University Langone Health's Ronald O. Perelman Department of Dermatology.

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Background Vulvar lichen sclerosus (LS) is a chronic dermatosis for which the true prevalence is not well established. LS remains an underrecognized and undertreated disease, and treatment patterns and differences among various specialties that care for patients with LS are largely unknown. Objective This study sought to determine the prevalence of diagnosed vulvar LS, demographic characteristics, and diagnostic and treatment patterns in the United States. Methods A database comprising >21.7 million women with commercial insurance in the United States was analyzed, and the largest cohort of patients with LS in the United States to date was identified. Results We found that obstetricians/gynecologists are diagnosing and managing approximately half of women with LS, and regardless of specialty, the majority of providers are appropriately prescribing high-potency topical steroids. Conclusion Our results suggest that LS may truly be underrecognized and underdiagnosed, especially in younger women.

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Background Survival disparities by race/ethnicity and socioeconomic status (SES) are observed in a wide range of pediatric treatment settings including oncology and solid organ transplantation. To date, few studies have examined the effects of race and SES on outcomes in pediatric allogeneic hematopoietic cell transplantation (HCT). We explored whether survival differed by race/ethnicity or SES in children receiving HCT for nonmalignant conditions at a single institution serving a diverse patient population. Procedures The Kaplan‐Meier method was used to estimate overall survival (OS) with the log‐rank test for between‐group comparisons. Cox proportional hazards models were used to identify risk factors for OS, adjusting for treatment‐ and disease‐related factors. Results Of 133 subjects, 0 to 21 years, 19% were non‐Hispanic (NH) white, 34% were NH black, 40% were Hispanic, and 7% were Asian. Sixty‐seven percent of the subjects had public insurance; 49% lived in neighborhoods with poverty rate ≥20%. Primary diagnoses included hemoglobinopathies (56%), bone marrow failure (22%), and other conditions (22%). Median follow‐up was 5.8 years (range 0.1‐14.5). Analysis revealed no difference in OS by race, insurance type, or neighborhood SES. Conclusions Findings from this single‐institution study suggest that in pediatric patients undergoing HCT for nonmalignant conditions, treatment at a tertiary care center with a multidisciplinary approach may mitigate drivers of disparities observed in other settings. Additional studies are now needed to further elucidate the complex interrelationships among race, SES, and clinical outcomes for children undergoing HCT.

Objective:Syndromic surveillance has been useful for routine surveillance on a variety of health outcomes and for informing situational awareness during public health emergencies. Following the landfall of Hurricane Maria in 2017, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented an enhanced syndromic surveillance system to characterize related emergency department (ED) visits.Methods:ED visits with any mention of specific key words (“Puerto,” “Rico,” “hurricane,” “Maria”) in the ED chief complaint or Puerto Rico patient home Zip Code were identified from the DOHMH syndromic surveillance system in the 8-week window leading up to and following landfall. Visit volume comparisons pre- and post-Hurricane Maria were performed using Fisher’s exact test.Results:Analyses identified an overall increase in NYC ED utilization relating to Puerto Rico following Hurricane Maria landfall. In particular, there was a small but significant increase in visits involving a medication refill or essential medical equipment. Visits for other outcomes, such as mental illness, also increased, but the differences were not statistically significant.Conclusions:Gaining this situational awareness of medical service use was informative following Hurricane Maria, and, following any natural disaster, the same surveillance methods could be easily established to aid an effective emergency response.

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