Introduction
Today I am joined by the amazing dermatologist, Dr. Sandy Flann, who is an expert on pediatric Lichen Sclerosus. Dr. Flann was the lead clinician for pediatric dermatology at the Orpington Hospital in the UK. She now works for West Kent Dermatology. She has been treating patients for over 20 years.
Yes, you heard that right, Pediatric Lichen Sclerosus!
As we know, Lichen Sclerosus can affect anyone, of any age – children included. Unfortunately, there is a lack of research and resources for parents of children with Lichen Sclerosus. So, today we're going to find out about treatment, what to look for, the progression of symptoms, and how we can help our children become comfortable in their skin.
This is an important episode if you have a child with LS, or if you plan on having children (as it’s important to know some of the warning signs to be able to advocate for your child). Furthermore, because there may be a genetic component to LS, you never know who in your family you may be able to help.
The Difference Between Treating Adult and Pediatric Lichen Sclerosus
The mainstay of treatment of Lichen Sclerosus is the same in adults as in children. Specifically, it includes the use of soap substitutes when you wash and the use of a potent topical corticosteroid. The topical steroid is to manage symptoms and help prevent architectural changes and bruising.
The biggest difference is the added challenge of getting children to the dermatologist or doctor to be properly diagnosed. In fact, I often hear from folks with LS that once they get their diagnosis, they begin to look back at their childhood and realize they’ve had it since they were little.
The Big Challenge of Diagnosing Pediatric Lichen Sclerosus
As a parent or caregiver, it can be hard to know what symptoms to look out for in pediatric Lichen Sclerosus, especially if you've never heard of LS.
It's especially concerning because childhood Lichen Sclerosus can begin in infancy, and Dr. Flann sees patients as young as four.
Children this young haven’t fully developed linguistic and communication skills. Therefore, they lack terms in their vocabulary such as ‘burning,’ ‘itching,’ ‘irritation,’ and ‘vulva.’ This can lead the parent/caregiver to have no idea anything is wrong.
What To Look For In Childhood Lichen Sclerosus
- Children might be very fidgety, and they can often be seen squirming in their chair.
- Constipation
- Sudden trouble using the bathroom
- Hands down their pants
- Chronic itching
Important Advice for Caregivers of Children with Pediatric Lichen Sclerosus
- Avoid over-checking your child’s vulva/genitals.
- As much as possible, treat them normally. Try not to fuss or hover too much.
- Remember, this condition is manageable, and they can grow up to live happy, fulfilling lives.
- They can play with their friends on different sports teams, and you just may need to be mindful of how it can impact them and make a few modifications. For example, if your child wants to be on the swim team, have them use a barrier cream like Vaseline on their vulva before swimming. These barriers will help protect them against chlorine which can be irritating. Be sure to have them rinse off afterward with a soap substitute.
Treatment for Childhood Lichen Sclerosus
Standard LS treatment is super topical steroids. Although, Dr. Flann may prescribe a lower potency steroid if the child is very young, under the age of six.
Doctors prescribe these strong medications to children to minimize the chance of the child scarring around the introitus, clitoris, and labia. They also do this because the risk of developing vulvar cancer is higher if the child is not adequately treated.
Dr. Flann avoids the second-line treatment of topical calcineurin inhibitors because they tend to sting, and she doesn’t like putting children through any unnecessary pain.
Pediatric Lichen Sclerosus Steroid Scheduling & Dosing
For adults, the general dosing schedule for Lichen Sclerosus is once a day for the first month, every other day for the second month, and then two times a week as maintenance for life. Listen to my interview with Dr. Jill Krapf to learn more about steroids and how to use them optimally.
This is the same protocol children with LS follow.
Dr. Flann has seen children where LS significantly calmed down with proper steroid use. Dr. Flann follows up with these patients every year to assess their health and potentially lower their steroid potency or amount.
Interestingly, children tend to respond much more rapidly to steroids than adults. Thus, Dr. Flann follows up frequently at the beginning of treatment.
How to Care for Your LS – Tips From An Experience
In addition to using steroids and getting monitored by a specialist, Dr. Flann recommends using soap substitutes and avoiding bubble baths, fragrances, and/or anything that lathers.
In the UK, they have prescription-grade emollients, often prescribed in addition to steroids. Otherwise, brands like Cerave, Aveeno, and QV gentle wash are all equally good products to wash your vulva with.
Regarding moisturizers, Dr. Flann leaves this to the patient’s discretion. However, she suggests patients do not apply moisturizer immediately after steroids. Steroid ointment can be quite oily; therefore, enough moisture should be there.
However, if patients find they are dry, they can use moisturizers between steroid applications to help with dryness.
When choosing your moisturizer, Dr. Flann recommends the moisturizer be SLS-free, fragrance-free, and have minimal ingredients to avoid contact dermatitis, aka an allergy.
Borax and Children – Is It Safe? What You Need to Know
Dr. Flann is aware of steroid fear. Dr. Flann explained that doctors have to follow evidence-based information and comply with their country’s guidelines.
To date, Dr. Flann notes no evidence-based information supports ingesting or soaking in borax to treat Lichen Sclerosus. Further, Dr. Flann notes the UK national body, the British Association of Dermatologists, released a statement in 2019 saying ingesting and soaking in borax is not recommended and shows no efficacy. Therefore, she cannot endorse using borax to treat Lichen Sclerosus.
What Happens to Childhood Lichen Sclerosus in Puberty
Some patients find their LS goes dormant in adolescence. Others may experience flares on and off throughout their teen years. The key, however, is to use steroids and stay monitored by a specialist.
Teenagers and Lichen Sclerosus
Getting teens into the office and building trust is the biggest challenge concerning teenagers with pediatric Lichen Sclerosus. Dr. Flann uses the first consultation to take the teen’s history, perform a clinical exam, make the diagnosis, and craft a treatment plan. Dr. Flann also provides lots of patient information leaflets explaining Lichen Sclerosus. She knows patients often forget everything the doctor tells them. She focuses heavily on building trust, educating patients, and giving them a proper and clear treatment plan.
As part of the education piece, Dr. Flann informs patients LS is an inflammatory skin condition that carries a risk of vulvar cancer if untreated. She also stresses the importance of self-monitoring via monthly vulva checks.
Dr. Flann addresses patients' concerns for the future by ensuring they can still get pregnant and have healthy babies. She makes herself a resource that will be there for them if sex becomes painful.
Is Lichen Sclerosus On The Rise: An Expert Weighs In
Recently, statistics have shown more and more folks are getting diagnosed with LS. However, I believe it is less a case of more people developing LS and more due to education, awareness, and less stigma.
Dr. Flann agrees. She believes awareness activism has done wonders to lessen the stigma and taboo around genitals and genital health. Younger generations are more comfortable discussing their vulvas than generations past, and this is great!
The more stigma lifts, the more awareness, and education, the sooner patients can get diagnosed instead of going decades untreated.
What We Can Do For Future Generations To Come
Although the climate is shifting – i.e., there is more awareness, education, and less stigma – there are still a lot of children and teens who are shy and/or do not feel comfortable discussing genital issues.
Advice for parents/caregivers:
- Work to create a safe space in your home.
- Have open and honest conversations with your child/children.
- Listen. Listen to your children. Watch their body language and check in with them while they speak/communicate.
- Try asking things like: “What was the best part of your day” and “What was the worst part of your day, or something you had trouble with.” Let them know regardless of whether it’s good or bad, you are loved, you are safe, and you can work through it.
Conclusion
In sum, treating the condition is pretty simple. The difficulty is getting children through the door, diagnosed, establishing trust, and opening communication links.
Once you have those in place, you can treat the disease and children can go on to live normal lives. Dr. Flann assures listeners children and teenagers with LS can live a normal, happy life.
If you want to reach out to Dr. Flann, you can reach her on her Instagram @Dr_SandyFlann. You can also check out her website, sandyflann.com.
Virtual Meetup Information
Did you learn anything new from this episode? Do you have a child with Lichen Sclerosus? Did you have childhood Lichen Sclerosus? Let me know! DM me at @lichensclerosuspodcast on Instagram.
Better yet, why not tell us at our Lichen Sclerosus Support Virtual Meetup!
We meet every other Saturday from 2-4 pm and 7-9 pm Eastern Standard Time. This is your opportunity to share your diagnosis story, what is working for you and what isn’t, and ask the group questions. Perhaps share your experience with pediatric Lichen Sclerosus!
I have met so many incredibly strong LS warriors through these meetups, and I would love for you to join our community.
Sign up for notifications and updates! I cannot wait to see your face and hear your voice!
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It's our private group where we learn how to tackle the mental and physical side of Lichen Sclerosus together. It's an intimate positive safe space to get evidence-based information from people who understand what we're going through.
