(112) Racial Differences in the Diagnosis of Juvenile Vulvar Lichen Sclerosis: A Retrospective Cohort Study.

Background: Juvenile anogenital lichen sclerosus (JVLS) is a chronic inflammatory skin condition diagnosed visually by identifying skin changes including white patches, shiny and wrinkled skin, fissures and/or petechiae. Recent years have seen increasing recognition of the underrepresentation of skin of color in medical training and dermatology textbooks. Whether this gap in racially comprehensive dermatologic training resources is associated with disparities in the diagnosis of JVLS in people of color remains unknown. This study aims to evaluate potential racial differences in the diagnosis of JVLS when comparing Black children to children who are not Black.

Methods: After IRB approval, we retrospectively collected data from children diagnosed with JVLS in a metropolitan area children’s hospital joint dermatology-gynecology clinic between February 2020 and September 2022. Statistical analysis was performed using SPSS version 28.0 (IBM Corp, Armonk, NY).

Results: A total of 58 children diagnosed with JVLS were included in the study. This data represents findings at their first visit. Almost half (n=26, 45%) identified as Black (Table 1). The mean age at onset of symptoms (5.1 + 3.0 yrs), diagnosis (6.3 + 3.1 yrs), and latency between symptoms onset and diagnosis (1.3 + 2.3yrs) did not differ when comparing Black to not Black children (Table 2). While the prevalence of presenting symptoms such as itching did not differ between the two groups, more children who were not Black had been prescribed a topical antifungal prior to their initial visit (p=.02). There were significant differences in the frequency of documented skin changes with a higher prevalence of shiny, wrinkled skin of the clitoral hood (p=.03) as well as white patches on the labia majora (p= .04), perineum (p=.04) and perianal (p=.02) areas of Black children. In contrast, although fissures were most identified on the perineum and perianal areas, the difference between the two groups was not significant. And, although Black children had a higher reported percentage of disease involvement of the labia majora (p=.02) and perineum (p=.04), there was no difference in the reported degree of disease severity between the 2 groups.

Conclusions: We report a difference between visual disease involvement and the perception of disease severity where Black children are classified as having less severe disease despite greater percentages of skin involvement. Future research is needed to identify and rectify potential diagnostic biases of vulvar dermatologic conditions in children with skin of color.