Lichen sclerosus: An audit looking at new patient referrals in Dermatology & Genito-urinary medicine clinics Todd S, Sherrey H, Emerson C. Department of Genito-urinary Medicine, Belfast HSC Trust, Belfast, UK Suzanne Todd ST3 GUM November 2014

Lichen sclerosus: Background True incidence under-estimated Often goes undiagnosed Chronic symptoms Complications

Aetiology Inflammatory dermatosis unknown aetiology Autoimmune factors Increased frequency of other autoimmune disorders

Clinical Features Itch Soreness Dyspareunia Urinary symptoms Others e.g. constipation Pale, white atrophic areas Purpura Fissuring Erosions Hyperkeratosis Loss of architecture

Complications Squamous cell carcinoma Clitoral pseudo-cyst Sexual dysfunction Dysaesthesia

Diagnosis Clinical appearance Biopsy

Management: New BASHH Guidelines Biopsy – diagnosis uncertain / other pathology Search for other auto-immune disease Skin swab Patch testing Patient education Ultra-potent steroid

Aim Retrospective case note review Clinics: Dermatology vulval (Dec – June 2012) Genito-urinary medicine clinic RVH (March 2013-2014) Data collected: demographics, symptoms, past medical history, investigations & management New BASHH guidelines Presentation / discussion To improve patient care, education & documentation

Dermatology clinic: RVH 71 new patient referrals 14 patients diagnosed lichen sclerosus All female Diagnoses No. of patients

Age of patient diagnosed with Lichen sclerosus

Lichen sclerosus: Presenting symptoms

Lichen sclerosus: Past Medical History No. PMH

Management 100 % topical steroid 46 % biopsy 0 patients had TFTs checked

Genito-urinary medicine clinic: RVH 15 patients diagnosed Lichen sclerosus 87% male & 13% female No. No. Sex Trust

Age of patient diagnosed with Lichen sclerosus

Presenting symptoms

Past medical history No. PMH

Management All patients treated with ultra-potent topical steroid 1 out of 15 patients had biopsy 3 out of 15 (20%) reviewed over 3 months 2 out of 15 (13%) annual review with GP No (0%) patients had testing for other autoimmune disorders 5 out of 15 (33%) patients DNA’d follow-up Documentation 1 patient given written information 2 cases documented patient education

Summary References: www.bashh.org/BASHH/Guidelines/ Significant difference between two patient groups Younger symptomatic males presenting to GUM service Testing for other auto-immune diseases not well adhered Patient education (TARGET 100%) Need to improve documentation Re-audit in 2015 References: www.bashh.org/BASHH/Guidelines/