Exploring diagnostic patterns of physician diagnoses in vulvar lichen sclerosus (VLS)

Summary: Abstract Body: VLS is a chronic inflammatory dermatosis of the anogenital region characterized by pruritus and changes to the skin texture that can increase risk of developing squamous cell carcinoma. VLS patients often experience delays in diagnosis and frequent misdiagnoses. This study examined the diagnostic pathways for VLS among patients, highlighting delays and the involvement of different specialties. An anonymous, electronic survey was distributed online to r/lichensclerosus on Reddit and the Lichen Sclerosus Support Group on Facebook. Respondents who were over 18 years old, spoke English, and reported a diagnosis of VLS by a licensed physician were included. From 82 respondents, a majority of patients (55; 67.1%) were diagnosed by gynecologists, followed by primary care providers (PCPs; 17; 20.7%), dermatologists (8; 9.8%), and other specialties (2; 2.4%). 72/82 participants sought medical care for their symptoms while 10/82 had their VLS discovered on a routine exam. Those who had their VLS diagnosed on a routine exam were all diagnosed by either gynecologists (7/10) or PCPs (3/10). 49/82 (59.8%) of respondents consulted more than one physician, with 33/82 (19.5%) seeing at least three different providers before receiving a diagnosis. Notably, of the 8 patients who were diagnosed by dermatologists, 50% saw dermatologists as the 3rd physician or more. The 2 patients who consulted dermatology as the initial provider received an immediate accurate diagnosis. Ultimately, most of our patients received diagnoses of VLS from PCPs or gynecologists, rather than dermatologists. Furthermore, patients are often diagnosed by dermatologists only after seeing additional providers, and none of our patients were diagnosed by dermatologists on routine exams. Our study, therefore, highlights an opportunity for dermatologists to enhance their role in diagnosing and managing VLS and to consider incorporating regular genital examinations into practice to help reduce time to diagnosis and improve patient care. Elyssa Kim¹, Trina Nguyen¹, Annalise Vaccarello¹, Kayley Erickson², Timmie Sharma² 1. Case Western Reserve University School of Medicine, Cleveland, OH, United States. 2. Department of Dermatology, University Hospitals, Cleveland, OH, United States. Clinical Research: Epidemiology and Observational Research