Dermatologic Conditions Misdiagnosed as Evidence of Child Abuse

To the Editor. —  The report by Mss Herman-Giddens and Berson¹ documenting traumatic genital care practices in children emphasizes once more the many and varied forms of child abuse. The putative numbers are mind-boggling and the harm done is immeasurable. As physicians, we must strive to the utmost to alleviate this intolerable situation, but scientific objectivity must not be sacrificed.I refer to case 3 in the article by Mss Herman-Giddens and Berson. It is clear that the behavior of the father is inappropriate and potentially harmful to the girl's psychosexual development. Examination of the photograph, however, points to a diagnosis of juvenile lichen sclerosus et atrophicus rather than the steroid effect suggested in the text. Of unknown etiology, evolution of the lesions takes place over a period of years, and resolution might not be complete until puberty. Symptoms that include burning micturition and chronic pruritus are common. I