Lichen Sclerosus in the Differential Diagnosis of Suspected Child Abuse Cases

Isaac, Reena; Lyn, Michelle A.; Triggs, Nicole

doi:10.1097/01.pec.0000280513.98289.e8

Cited by 15 publications

(5 citation statements)

References 7 publications

(10 reference statements)

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“…Trauma, injury, and sexual abuse have been suggested as possible triggers of VLS in genetically predisposed people through the Köebner phenomenon mechanism. 31 An alarming but interesting study was performed by Warrington et al 19 on 42 girls affected by VLS. Among them, sexual abuse was confirmed in 12/42 cases (28.6%), suggesting that the diagnosis of VLS does not exclude coexistent sexual abuse.…”

Section: Discussionmentioning

confidence: 99%

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Vulvar vitiligo and lichen sclerosus in children: A clinical challenge

Veronesi

Virdi

Leuzzi

et al. 2021

Pediatric Dermatology

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Vulvar vitiligo (VV) and vulvar lichen sclerosus (VLS) are two acquired inflammatory dermatoses characterized by hypo-or depigmentation of the skin and mucosa. Differential diagnosis can be challenging, and biopsy may be required to promptly recognize VLS and prevent irreversible scarring of the vulva. Additionally, these two conditions can also occur in association. This relationship is not surprising given the presumptive autoimmune pathogenesis of both diseases. The aim of this study was to review the clinical and dermoscopic features of VV and VLS in children and to define how they are associated.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, the diagnosis offers many challenges to the clinician. Trauma, injury, and sexual abuse have been suggested as possible triggers of VLS in genetically predisposed people through the Köebner phenomenon mechanism 31 . An alarming but interesting study was performed by Warrington et al 19 on 42 girls affected by VLS.…”

Section: Discussionmentioning

confidence: 99%

Vulvar vitiligo and lichen sclerosus in children: A clinical challenge

Veronesi

Virdi

Leuzzi

et al. 2021

Pediatric Dermatology

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“…Ecchymoses are almost pathognomonic of genital LS. In girls, these violaceous macules should not be misinterpreted as a result of sexual abuses [17].…”

Section: Signsmentioning

confidence: 99%

Vulvar dermatosis

Moyal‐Barracco¹,

Wendling²

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

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Vulvar dermatoses are inflammatory conditions responsible for chronic or recurrent itching and soreness. The lesions are either circumscribed to the vulva or associated with extragenital localizations which may help to assess the diagnosis. They should be differentiated from infectious or neoplastic diseases which may have clinical similarities. As opposed to the majority of all dermatoses that have a benign and regular course, lichen sclerosus or lichen planus could exceptionally foster the occurrence of an epithelial cancer precursor which may evolve to squamous cell carcinoma. Topical corticosteroids are the mainstay treatment of vulvar dermatosis. We do not know if the treatment of vulvar lichen sclerosus and vulvar lichen planus prevents squamous cell carcinoma.

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“…), infections or also sexual abuse are thought to increase the efflorescences. This socalled Koebner response appears to have a triggering function [5]. The diagnosis of LS therefore in no way rules out previous sexual abuse.…”

Section: Discussion ▼mentioning

confidence: 99%

“…In the literature available to us there are only isolated reports about difficult differentiations between LS and sexual abuse. For example, Isaac et al reported about a similar case in the USA with tragic consequences of the attempted further suicide of the child's mother [5]. In Saudi Arabia, Al-Khenaizan et al reported about a 3yearold girl with LS.…”

Section: Discussion ▼mentioning

confidence: 99%

Lichen sclerosus Mistaken for Sexual Abuse – Prevention of Victimization

2014

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This case report describes the forensic examination of 7 girls aged between 4-11 years with suspected sexual abuse. The children had been reported by local pediatricians, hospital physicians or authorities such as the youth welfare office and police due to mucosal changes in the anogenital area. All children presented with a clearly delimited, porcelain-like white discoloration of the skin in the anal and genital area with atrophic conversion to parchment-like skin. The markedly vulnerable skin exhibited very different manifestations of hemorrhagic dermal and mucosal defects in the area of the labia, the clitoris, the perineum and the perianal region. The hymen was intact in all cases. The skin changes are typical of lichen sclerosus et atrophicus, which is more common in prepubertal girls and post-menopausal women. Due to the chronic course, affected persons can develop sclerotic plaques, synechia of the labia minora and stenoses of the urinary tract and of the vaginal orifice, so that an early diagnosis is crucial. This condition is not infrequently taken by attending physicians as a sign of suspected sexual abuse, as the relevant findings are not recognized correctly. Furthermore, there are far-reaching consequences for the affected families, who are often faced with criminal prosecution, a breakdown of social familial structures and an enormous psychological burden for the affected persons. To avoid victimization there is an urgent need for more information about the differential diagnoses of sexual abuse and a call for interdisciplinary co-operation when evaluating abnormal anogenital findings in children.

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Lichen Sclerosus in the Differential Diagnosis of Suspected Child Abuse Cases

Cited by 15 publications

References 7 publications

Vulvar vitiligo and lichen sclerosus in children: A clinical challenge

Vulvar vitiligo and lichen sclerosus in children: A clinical challenge

Vulvar dermatosis

Lichen sclerosus Mistaken for Sexual Abuse – Prevention of Victimization

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