Long-term evolution of prepubertal-onset anogenital lichen sclerosus: A 35-year retrospective and cross-sectional study from a single tertiary care maternal and pediatric center

Background: Anogenital lichen sclerosus (ALS) in children may persist after puberty with potential clinical repercussions. Objective: The purpose of this study was to evaluate postpubertal evolution of girls with ALS diagnosed in the prepubertal period based on physical examination, the persistence of functional symptoms, and the effect on quality of life. Methods: We retrospectively reviewed 65 cases of girls with prepubertal-onset ALS. Onset, signs/ symptoms, photos, evolution, and treatment were collected from the medical records. Subsequently, 30 of these 65 patients were assessed for persistence of signs/symptoms by physical examination and/or standardized questionnaire. Results: Signs of active disease after puberty based on physical examination were present in 92% (N = 23) of examined patients. A high proportion of cases with persistent ALS after puberty were asymptomatic (47%, N = 14). Limitations: This is a single-center retrospective study with a limited number of patients. Half of our original cohort could not be reached or declined a follow-up visit. Conclusion: Prepubertal lichen sclerosus is a chronic condition that can be asymptomatic after puberty despite continued disease activity. We recommend long-term follow-up of patients with prepubertal ALS to prevent associated morbidity. ( J Am Acad Dermatol 2025;92:1010-4.)