{"paper_id":"4cf34c79-78c8-46df-921b-fad9ca1963ce","body_text":"A Longitudinal Multiinstitutional Study of Vulvar Lichen Sclerosus: From Childhood to Perimenopause\n- Jacopo Di Giuseppe1\n- Giovanni Delli Carpini1\n- Luca Giannella1\n- Tomas Terenzi1\n- Mariasole Fichera1\n- Federica Ragno1\n- Anna Campanati2\n- Veronica Boero3\n- Carlotta Caia3\n- Elisa Pesce3\n- Paolo Vercellini4\n- Barbara Gardella5\n- Mattia Dominoni5\n- Arsenio Spinillo5\n- Francesco Sopracordevole6\n- Nicolò Clemente6\n- Anna Del Fabro6\n- Riccardo Rossi7\n- Monica Corazza8\n- Alessandro Borghi8\n- Ruby Martinello9\n- Pantaleo Greco9\n- Giuseppe Rizzo10\n- Anna Angela Criscuolo10\n- Ilenia Mappa10\n- Enrico Matteini11\n- Elisabetta Botti11\n- Elena Campione11\n- Luca Bianchi11\n- Andrea Ciavattini1\nObjective\nThe main outcome of this study was the evaluation of clinical characteristics, comorbidities, and therapeutic approaches in patients with vulvar lichen sclerosus (VLS) aged from childhood to perimenopause. Secondly, it was intended to compare these characteristics according to the menarchal status.\nMethods\nPatients less than 45 years of age with a diagnosis of VLS from January 2002 to June 2022 in 10 referral centers were included in this retrospective longitudinal study. The univariate analysis compared the dependent variables according to menarchal status.\nResults\nOne hundred eighty-six patients met the inclusion criteria. At diagnosis, between 25% and 40% of premenarchal patients reported signs related to subepithelial hemorrhage. A significantly greater presence of bleeding (p < .005), easy bruising (p = .028), fissures (p = .008), petechiae/splinter hemorrhages (p < .001), and bleeding/blistering or open sores (p = .011) was observed in premenarchal patients with respect to the postmenarchal group. The perineum (p = .013) and the perianal region (p < .001) were significantly more involved in the premenarchal group. Topical calcineurin inhibitors were more used in the premenarchal population (p = .004), whereas vitamin E oil and moisturizers were more used in the postmenarchal population (p = .047).\nConclusions\nVulvar lichen sclerosus is a chronic condition that can cause vulvar changes that result in severe morbidity and affects sexual function and quality of life, even before menopause. Vulvar lichen sclerosus continues to be misdiagnosed in this population. This may lead to an average delay from symptom onset to diagnosis. Evaluating clinical manifestations of VLS in premenarchal and postmenarchal age allowed us to find different clinical characteristics between the 2 periods suggestive of the diagnosis.","source_license":"public-domain-us","license_restricted":false}