30. Comparison of Signs & Symptoms among Pediatric Patients with Lichen Sclerosis (LS) & Vitiligo: Preliminary Findings from an Interdisciplinary Vulvar Dermatology Clinic

Background Differentiating pediatric vulvar lichen sclerosis versus vitiligo is a clinical challenge. For both conditions, patients often have a delayed or initial misdiagnosis. Both conditions classically present with hypopigmentation, while LS is more likely to present with symptoms such as pruritus, bleeding, and pain. We aim to add to the existing literature by comparing signs and symptoms in a cohort of patients with either conditions. Methods A retrospective case control study was performed at a single tertiary children's hospital from January 2016 to September 2022. Diagnosis was made by visual inspection by both a pediatric gynecologist and a pediatric dermatologist. Biopsy is not routinely performed for diagnosis. Data collected included demographic information, presenting signs and symptoms, and treatment regimens. Additionally, this interdisciplinary clinic utilizes a standardized collection form for all notes including a detailed dermatologic assessment. This allows us to both monitor patient's disease progression as well as standardize care. For statistical analysis we utilized a test of independence (Pearson's Chi Squared versus Fisher's Exact) Results Within our study time frame, there was n=80 patients diagnosed with LS and n=18 with vitiligo. Vitiligo and LS had a similar age at presentation (5 and 6 respectively). Ethnicity was similar between the 2 groups, while vitiligo had a higher percentage (55% versus 35%) of African American patients (p< 0.001). Pruritus was a common symptom in both conditions (70% LS and 33.3% vitiligo). Symptoms of vulvar pain (15%), pain with defecation (15%), and bleeding (8.75%) were seen in LS patients, while none of the vitiligo patients had those symptoms. Figure of 8 and clitoral involvement were seen in both conditions as well. Both conditions involved the perianal region and perineum. Conclusions Vitiligo and LS are challenging to differentiate; however, these data support pain (either vulvar or pain with defecation) and bleeding as more commonly seen in LS compared to vitiligo; however, most patients with LS did not present with these symptoms. These findings also support the importance of interdisciplinary clinics given the overlap of these conditions with varying treatment and long-term implications. Future direction will include evaluating outcomes on management options as well as identifying similarities in patients with LS flares.