Symptom influence and diagnostic challenges in vulvar lichen sclerosus

Summary: Abstract Body: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition of the genital area that can cause itching, scarring, and increased risk of squamous cell carcinoma. Prompt diagnosis addresses symptom management and mitigates malignancy risk. However, VLS diagnosis takes 4-5 years on average after symptom onset, potentially due to the overlap of VLS symptoms with other conditions. This study aims to characterize VLS symptoms and examine their influence on diagnostic outcomes. An electronic questionnaire was distributed on the r/lichensclerosus subreddit and the Lichen Sclerosus Support Group on Facebook to collect information on diagnostic experience. Adult English-speaking patients who reported receiving a licensed physician's diagnosis of VLS were considered. Descriptive statistics were used to analyze data. All 82 participants (100%) reported symptoms before diagnosis, with 72/82 (88%) seeking medical care for symptoms. Common symptoms included vulvar itching (n=71, 86.6%), white/shiny scar-like skin (n=56, 68.3%), vulvar irritation/burning (n=51, 62.2%), vulvar fissures or red/inflamed skin (n=46, 56.1%), skin fragility (n=44, 53.7%), change to genital appearance (n=42, 51.2%), vulvar dryness (n=39, 47.6%), vulvar soreness (n=38, 46.3%), and genital pain that occurs just before, during, or after sex (n =38, 46.3%). Multi-variable statistics revealed that participants with vulvar itching were 7.6 times more likely to seek care as compared to other symptoms. This suggests that women may be more likely to perceive itching as abnormal compared to other symptoms. Women reporting pain with sex were 9.8 times more likely to be misdiagnosed compared to other symptoms. These findings highlight the need for improved clinical awareness of VLS symptomatology, especially concerning pain associated with intercourse and other non-pruritic symptoms. Broadening the differential to include VLS when patients present with such symptoms can lead to timelier detection and improve quality of life. Trina Nguyen^{1, 2}, Annalise Vaccarello^{1, 2}, Elyssa Kim^{1, 2}, Kayley Erickson^{2, 1}, Timmie Sharma^{2, 1} 1. Case Western Reserve University, Cleveland, OH, United States. 2. University Hospitals, Cleveland, OH, United States. Clinical Research: Epidemiology and Observational Research