Peri-clitoral Epidermal Inclusion Cyst as Initial Presentation of Lichen Sclerosus in a Pediatric Patient

J Pediatr Adolesc Gynecol. 2024 Aug;37(4):448-450. doi: 10.1016/j.jpag.2024.01.005. Epub 2024 Jan 24.

Abstract

Background: Lichen sclerosus (LS) is a chronic inflammatory disorder, presenting with pruritis and hypopigmentation of the vulvar and anogenital skin. LS presenting as a peri-clitoral mass has not been previously described.

Case: A 5-year-old patient with vulvar pruritis and ultrasound showing a homogenous mass was referred for suspected clitoromegaly with normal labs. Examination demonstrated a prepubertal patient with a mobile, soft, peri-clitoral mass and surrounding hypopigmentation consistent with LS. The cyst was excised surgically; pathology revealed an epidermal inclusion cyst. Postoperatively, she began using topical steroids for LS with symptom resolution.

Conclusion: Thorough workup of clitoromegaly negative for hormonal causes requires further investigation to determine an alternative etiology of the mass. We suspect that inflammatory changes of LS and pruritus resulted in the peri-clitoral inclusion cyst.

Keywords: Epidermal inclusion cyst; Pediatric; Vulvar lichen sclerosus.

Publication types

  • Case Reports

MeSH terms

  • Child, Preschool
  • Clitoris* / pathology
  • Epidermal Cyst* / complications
  • Epidermal Cyst* / diagnosis
  • Epidermal Cyst* / diagnostic imaging
  • Epidermal Cyst* / pathology
  • Epidermal Cyst* / surgery
  • Female
  • Humans
  • Lichen Sclerosus et Atrophicus / complications
  • Lichen Sclerosus et Atrophicus / diagnosis
  • Vulvar Diseases / diagnosis
  • Vulvar Diseases / etiology
  • Vulvar Diseases / surgery
  • Vulvar Lichen Sclerosus / complications
  • Vulvar Lichen Sclerosus / diagnosis