Dermatologic Conditions Misdiagnosed as Evidence of Child Abuse-Reply

In Reply.—  Lichen sclerosus et atrophicus is one of a number of diagnoses that can be mistaken for evidence of sexual abuse. We appreciate the comments of Drs Anders, Smith, and Koblenzer in providing the opportunity to discuss this condition. As the authors point out, misdiagnosis in child abuse may have even more serious ramifications than in many other areas of pediatrics. It is paramount that professionals who specialize in child abuse be familiar with differential diagnoses that include other conditions that might present as apparent physical or sexual abuse. Indeed, one must be familiar with endocrinologic and metabolic disorders, inflammatory bowel diseases, and infectious diseases as well as the field of dermatology. We, too, have seen several patients with lichen sclerosus et atrophicus who have been mistakenly diagnosed and referred to us because it was believed that the children were being abused sexually. Recently, we evaluated a 6-year-old girl