Study Objective

To determine the frequency of persistence of vulvar lichen sclerosus (LS) through the pubertal transition and assess if the symptomatology and exam findings differ by menarchal status at onset of symptoms

Design

A retrospective cohort study

Setting

Academic tertiary care hospital

Participants

Females aged 21 years or younger with a diagnosis of vulvar LS

Intervention

None

Main Outcome Measures

Menarchal status at symptom onset, presenting symptoms, exam findings, persistence after menarche

Results and Conclusions

Of the 196 patients who met criteria, 141 were premenarchal and 55 postmenarchal. Of these 55, 36 had postmenarchal symptom onset, and the others had premenarchal symptom onset or LS diagnosis. Over the data review period, 26 patients were followed through the pubertal transition, and 10 (38.5%) had continued symptoms of LS. The premenarchal group (n = 141) was significantly more likely than the symptom-onset postmenarchal group (n = 36) to present with vulvar itching (70.2% vs 52.8%; P = .048), vulvar bleeding (26.2% vs 5.6%; P = .008), and bowel symptoms (16.3% vs 0%; P = .009). The premenarchal group was significantly more likely on exam to have subepithelial hemorrhages (24.8% vs 5.6%; P = .01). The postmenarchal group had more clitoral adhesions (25.0% vs 4.3%; P < .0001) and loss of labia minora (47.2% vs 2.1%; P < .0001). Thirteen postmenarchal patients presented with dyspareunia. This study suggests that premenarchal LS can persist after menarche in about 40% of adolescents and can initially develop in postmenarchal adolescents. Initial symptoms and exam findings differ on the basis of menarchal status. Continued surveillance is recommended.

中文翻译：

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整个儿童期和青春期的硬化性地衣：不仅是初潮前疾病

学习目标

确定外阴硬化性苔藓 (LS) 在青春期过渡期间持续存在的频率，并评估症状和检查结果是否因症状发作时的月经状态而异

设计

一项回顾性队列研究

环境

学术三级医院

参加者

诊断为外阴 LS 的 21 岁或以下女性

干涉

没有任何

主要观察指标

症状发作时的月经状态、出现症状、检查结果、月经初潮后的持续性

结果和结论

在符合标准的 196 名患者中，141 名处于初潮前，55 名处于初潮后。在这 55 人中，36 人有月经后症状发作，其他人有月经前症状发作或 LS 诊断。在数据审查期间，对 26 名患者进行了青春期过渡随访，其中 10 名 (38.5%) 有持续的 LS 症状。初潮前组 ( n  = 141) 明显比初潮后组 ( n  = 36) 更容易出现外阴瘙痒 (70.2% vs 52.8%; P  = .048)、外阴出血 (26.2% vs 5.6%) ；P  = .008）和肠道症状（16.3% 对 0%；P  = .009）。经前组在检查时更容易出现上皮下出血（24.8% 对 5.6%；P =.01）。月经后组有更多的阴蒂粘连（25.0% 对 4.3%；P < .0001）和小阴唇缺失（47.2% 对 2.1%；P < .0001）。13 名初潮后患者出现性交痛。这项研究表明，大约 40% 的青少年在月经初潮后会持续存在月经前 LS，并且最初会在月经后青少年中发展。初始症状和检查结果因月经状态而异。建议继续监测。