Patients may present with vaginal bleeding or concern for trauma Lichen sclerosis will cause permanent scarring and sexual dysfunction if untreated LICHEN SCLEROSIS Lichen sclerosis is an uncommon, inflammatory, chronic skin disorder that most often affects the vulva It is thought to be an autoimmune disorder In this condition, lesions are white, flat-topped papules, plaques, or atrophic patches involving the vulvar and perianal skin in a “figure 8” pattern around the vulvar and perianal areas The involved area is usually well demarcated Purpura is a hallmark finding when there is vulvar involvement Patients may present with vulvar pruritus, pain, dysuria, or bleeding from the affected tissue Findings may also be misinterpreted as trauma causing parents to bring their child in for concern of possible sexual abuse Diagnosis in children can usually be made by visual inspection In addition to the white, “figure 8” appearance of the affected skin, ecchymoses, fissures/erosions, and telangiectasias are frequently present ( Fig 92.5 ) Lichen sclerosis does not affect the vaginal mucosa Lichen sclerosis can lead to loss of the normal labia and architecture of the vulva causing long-term sexual dysfunction if not treated Therefore, goals of treatment are proper identification and initiation of treatment to prevent long-term effects Treatment is with topical, high-potency corticosteroids (clobetasol 0.05% ointment) applied to the affected area twice daily for weeks Patients should be reexamined at weeks to assess for response Patients usually require to 12 weeks of treatment with topical steroids until symptoms and visible findings have resolved After this point, the topical steroid should be tapered to avoid rebound that can be seen with abrupt cessation Immunomodulators are an alternative to topical steroids The disorder has a waxing and waning course, with many patients experiencing frequent recurrences For the majority of patients, the disorder resolves after menarche; however, a small proportion of patients may have persistent disease