Clinical features and therapeutic approaches of genital lichen sclerosus in children: results of an observational monocentric study

Lichen sclerosus is a chronic, progressive, inflammatory skin disease that presents unique challenges, particularly in the pediatric population, where limited data exist regarding its manifestation and optimal management. This retrospective observational monocentric study aims to provide insights into the clinical characteristics and therapeutic strategies employed, in a cohort of children and adolescents with genital lichen sclerosus. A comprehensive analysis was conducted involving a cohort of 60 pediatric patients ranging from 1 to 15 years old, all diagnosed with lichen sclerosus. These cases were referred to the Pediatric Dermatology Regional Center of the University of Padua, Italy, between January 2018 and January 2022. Moreover, we propose a treatment protocol that showed beneficial outcomes in all of our patients. Specifically, the initial use of mid-potency topical corticosteroids has proven effective in addressing severe acute flares. Following this acute phase, transitioning to long-term treatment with topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, has demonstrated effectiveness in maintaining remission of the disease and also shown efficacy in treating mild cases. The therapeutic effectiveness was assessed by considering various clinical aspects, including erythema, paleness, skin erosions, and specific symptoms such as itching, burning, and pain. Erythema emerged as the predominant clinical sign, reported in 43 (78.3%) patients, followed by paleness, reported in 17 (28.3%) patients. Pruritus was observed in 25 girls (58.1% of females) and 2 boys (11.8% of males), while pain and burning sensations were predominantly reported in female children. Among females, we observed a higher prevalence of cutaneous comorbidities, such as atopic dermatitis, psoriasis, alopecia areata, and linear scleroderma, as opposed to autoimmune systemic diseases, that were more prevalent in males. Regarding therapeutic approaches, 21 (35.0%) patients applied topical corticosteroids, 28 (46,7%) applied topical tacrolimus and 21 (35,0%) applied topical pimecrolimus. All treated patients experienced notable benefits following the initiation of treatment proposed by our protocol. This study provides further insights into the clinical presentation and management of lichen sclerosus in the pediatric population, shedding light on potential therapeutic pathways for optimizing patient outcomes in this specific demographic. The proposed protocol appears to be a promising strategy, especially when the onset of the disease occurs during childhood.