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June 23, 1989

Dermatologic Conditions Misdiagnosed as Evidence of Child Abuse

JAMA. 1989;261(24):3547. doi:10.1001/jama.1989.03420240061011

To the Editor.—  We appreciate the continuing efforts of professionals such as Mss Herman-Giddens and Berson1 in the nationwide effort to identify and intervene in child abuse cases. Their article on three cases of child molestation under the guise of genital care of children is a sobering reminder of the intricacies of the problem.The photograph and clinical description of the genital lesions in case 3 of the article, however, are striking because of their resemblance to the dermatologic condition lichen sclerosus et atrophicus. This condition is characterized frequently in females by ivory papules coalescing to plaques in a "keyhole" distribution around the vagina and rectum. It can be associated with severe pruritus, irritation, and even bleeding and may require various forms of topical therapy for control of symptoms. The etiology is unknown, but lichen sclerosus et atrophicus occurs more frequently in females, often involving only the genitalia. It