Pediatric emergency medicine trisk 1542 1542
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FIGURE 79.1 Diagnostic approach to vaginal bleeding before normal menarche.
Lichen Sclerosis
Although bleeding per se is not common, ecchymoses, fissures, and
telangiectasias are frequent clinical manifestations of lichen sclerosis, a chronic,
idiopathic skin disorder in children that most often affects the vulva. In this
condition, white, flat-topped papules gradually coalesce to form atrophic plaques
that involve the vulvar and perianal skin in a symmetric hourglass pattern. Topical
treatment with corticosteroids or an immunomodulator is helpful in most cases.
Consultation with a specialist is suggested for management of this uncommon
disorder.
Vaginal Bleeding
Bleeding in the Neonate
During the first 2 weeks of life, hormonal fluctuations may produce physiologic
endometrial bleeding. Before female infants are born, high levels of placental
estrogen from the mother stimulate growth of both the uterine endometrium and
the breast tissue. As this hormonal support decreases after birth, some infants
have an endometrial slough that results in a few days of light vaginal bleeding.
The bleeding will stop spontaneously and requires no treatment except parental
reassurance. A further workup is necessary if the bleeding persists after 3 weeks.
