[Vulvar lichen sclerosus in children misdiagnosed as sexual abuse].
BACKGROUND
With the frequency of lawsuits for sexual abuse increasing, high-quality care for victims is of utmost importance. Genital examination is difficult to perform, especially on children, but is a key item for diagnosis. A case report is presented herein to illustrate this issue.


METHODS
A sexual assault was suspected on 2.5-year-old female twins. Clinical examination primarily detected vulvar micro-hematoma and hypopigmentation, discreetly sclerosing, as well as atrophic labia and a beginning of lichenification on one of them. The other twin showed an unspecific and erythematous lesion. Elimination of the supposedly dangerous environment and a remote consultation brought out a paradoxical development to the story and confirmed the diagnosis of vulvar lichen sclerosus.


CONCLUSIONS
Traumatic lesions caused by sexual abuse are uncommon. Coexisting allegations and lesions in the genital area lend support to the hypothesis of sexual abuse. However, genital-anal tropism dermatosis can mimic traumatic injuries. Lichen sclerosus is an example of a differential diagnosis of vulvar traumatic lesions, which is quite often unknown to physicians, including pediatricians. This case report shows that taking the appropriate time in multidisciplinary councils can suggest a differential diagnosis. Nonetheless, it should be remembered that identifying the pathology behind the lesions cannot allow the physician to negate the child's story about potentially sexual acts, although the truth of this story and the perpetrator must still be proven by a court of law.
Aix Marseille université, CNRS, EFS, ADES UMR 7268, 13916 Marseille, France; Service de médecine légale et droit de la santé, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France. Electronic address: emmanuelle.delmarre@ap-hm.fr.
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Delmarre
Aix Marseille université, CNRS, EFS, ADES UMR 7268, 13916 Marseille, France; Service de médecine légale et droit de la santé, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Delteil
Service de dermatologie, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Mallet
Service de médecine légale et droit de la santé, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Boval
Aix Marseille université, CNRS, EFS, ADES UMR 7268, 13916 Marseille, France; Service de médecine légale et droit de la santé, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Capasso
Aix Marseille université, CNRS, EFS, ADES UMR 7268, 13916 Marseille, France; Service de médecine légale et droit de la santé, hôpital Timone adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Piercecchi-Marti
D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004200:Diseases in Twins / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007724:Vulvar Lichen Sclerosus / Q000175:diagnosis*