1. 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

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

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

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

6. Complications Squamous cell carcinoma Clitoral pseudo-cyst
Sexual dysfunction
Dysaesthesia

8. Diagnosis
Clinical appearance
Biopsy

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

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

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

12. Age of patient diagnosed with Lichen sclerosus

13. Lichen sclerosus: Presenting symptoms

14. Lichen sclerosus: Past Medical History
No.
PMH

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

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

17. Age of patient diagnosed with Lichen sclerosus

18. Presenting symptoms

19. Past medical history
No.
PMH

20. 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

21. 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: