SynthesisPediatric dermatology
Pediatric Lichen Sclerosus and Non-Accidental Trauma: A Systematic Review of Distinguishing Features and Co-Occurrence.
Synthesis in Pediatric dermatology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND/
objectivesLichen sclerosus (LS) is a chronic autoimmune inflammatory skin disease predominantly affecting the anogenital area that can be mistaken for non-accidental trauma (NAT) in pediatric patients, such as sexual abuse. Such misdiagnoses can be distressing for families. This systematic review examined pediatric patients investigated for both LS and NAT to provide clinicians with guidance on distinguishing these conditions.
methodsMEDLINE, Embase, and Web of Science were searched. Retrospective studies, case series, and case reports describing pediatric patients investigated for both LS and NAT were included. Descriptive statistics were used to analyze data due to heterogeneity in study designs and reporting.
resultsOf 113 studies identified, 25 studies encompassing 146 patients were included. The suspected NAT was sexual abuse in all cases (N = 146). The final diagnosis was LS in 130 patients (89.0%), and LS and sexual abuse in 16 patients (11.0%). Patients who experienced sexual abuse often had known offenders in their families (n = 6/13) and displayed withdrawn or hypersexualized behavior (n = 2/13, unreported in n = 3/16), while those without abuse exhibited age-appropriate behavior (n = 8/41) and denied sexual abuse (n = 6/41) and demonstrated positive interactions with caregivers (n = 4/41, unreported in n = 89). On exam, hymenal disruption or scarring (n = 8/13) was more common in abused patients, whereas those without abuse typically lacked trauma to the hymen (n = 27/41) or anus (n = 10/41).
conclusionsLS and sexual abuse may co-occur. Careful assessment of patient behaviors, home environment, and anogenital findings is crucial to avoid misdiagnoses that may be distressing for families. Limitations include small sample size, and lack of statistical comparisons.
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