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Lichen sclerosus: An audit looking at new patient referrals in Dermatology & Genitourinary 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 l Skin swab l Patch testing l Patient education l Ultra-potent steroid l 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 l l l Diagnoses No. of patients Age of patient diagnosed with Lichen sclerosus No. Age of Patient Lichen sclerosus: Presenting symptoms Lichen sclerosus: Past Medical History No. PMH Management 100 % topical steroid l 46 % biopsy l 0 patients had TFTs checked l Genito-urinary medicine clinic: RVH •15 patients diagnosed Lichen sclerosus •87% male & 13% female No. No. Trust Sex Age of patient diagnosed with Lichen sclerosus No. Age 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 •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/