108. Visual Diagnosis of Anogenital Lichen Sclerosus in Children and Adolescents: A Survey Study.

Pediatric anogenital lichen sclerosus (LS) can be difficult to differentiate from other vulvar dermatoses. While biopsy is performed in adults, in children diagnosis is primarily visual with unknown accuracy. We sought to assess the accuracy of visual diagnosis of pediatric anogenital LS. An IRB approved survey was disseminated via REDCap to listserv members of NASPAG in 2022. The survey included 13 de-identified images of the anogenital area obtained after consent with 4 possible diagnostic choices: vitiligo, LS, non-specific vulvovaginitis, and other. Clinical history was not provided. Participants' responses were compared to the clinical diagnosis of an experienced pediatric gynecologist and pediatric dermatologist who evaluated each patient during a multidisciplinary vulvar dermatology clinic. Statistical analysis was performed using SPSS. Categorical variables were compared among groups using the χ2 test or Fishers' exact test. Statistical significance was defined as a P value less than.05. The 34 respondents who completed the survey included 28 pediatric gynecologists, 3 Ob/Gyn, 1 adolescent medicine specialist, 1 pediatric gynecology nurse practitioner and 1 pediatric gynecology fellow (Table 1). More than half (71%, n=24) reported being in practice greater than 10 years and at academic centers (79%, n=27). Only 12% (n=4) reported having a designated vulvar dermatology clinic at their institution. More than half of the respondents (56%, n=19) reported seeing 6 or more pediatric patients with LS or vitiligo per 3 months. The majority (94%, n=32) reported white non-Hispanics as representing a substantial portion of their patient population. Black or African American children comprised a substantial proportion of only 18% (n=6) of respondents. None of the 34 respondents correctly visually diagnosed all 13 cases (Table 2). Only 4 of 10 LS cases were correctly identified by >50% of respondents. Of the 6 LS cases not correctly identified by the majority, vitiligo was most frequently chosen as the diagnosis. Both vitiligo cases were identified correctly by a majority of respondents. Accuracy of diagnosis of LS was not statistically significantly associated with years of practice (p=.26), practice setting (p=.36), designated vulvar dermatology clinic (p=.74) or number of patients (p=.09). Accurate diagnosis of pediatric anogenital LS may not be based on visual examination alone. Further studies are needed to evaluate the effect of knowledge of symptoms and differences in training (as with dermatologists) on diagnostic accuracy. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1381262-1-ANY.docx https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1381262-2-ANY.docx [ABSTRACT FROM AUTHOR]