Vulvovaginal Complaints as the First Manifestation of Crohn's Disease in Children: Case Report

Vulvar skin disease in the pediatric population

“…Extraintestinal manifestations of inflammatory bowel disease (IBD) affect nearly one third of patients, with vulvar skin changes seen more commonly in children than adults [18]. Patients with vulvar manifestations of Crohn's disease (CD) most commonly present with painless vulvar edema and histologic evidence of noncaseating granulomas, also called granulomatous vulvitis (GV) [18,19].…”

“…In metastatic CD, lesions are separated from gastrointestinal disease by healthy tissue, or they may even be the sole manifestation of CD [20,21,22 ▪▪ ]. In either subtype, vulvar lesions may precede or accompany the classical gastrointestinal symptoms of abdominal pain, diarrhea, and delayed growth [18]. Outside of painless vulvar edema, other possible signs include fistulae, abscesses, knife-cut ulcerations, lymphedema, and perianal skin tags [18].…”

“…In either subtype, vulvar lesions may precede or accompany the classical gastrointestinal symptoms of abdominal pain, diarrhea, and delayed growth [18]. Outside of painless vulvar edema, other possible signs include fistulae, abscesses, knife-cut ulcerations, lymphedema, and perianal skin tags [18]. Of note, a recent study has highlighted both shared clinical features of and higher rates of comorbid hidradenitis suppurativa (HS) in the CD population, making distinguishing between the two an important clinical consideration during evaluation of a patient with vulvar abscesses, plus or minus signs of IBD [23 ▪ ].…”

“…VCD requires intervention, as lesions are unlikely to heal without treatment. Therapy depends upon the level of gastrointestinal involvement and, as described in the latest publications, may include topical or systemic corticosteroids, oral metronidazole, antibiotics, azathioprine, infliximab, adalimumab, and even surgery [18–21,22 ▪▪ ]. Surgery is generally reserved for lesions refractory to medical treatment or those that require debridement, drainage, or excision [18–21,22 ▪▪ ].…”

“…Therapy depends upon the level of gastrointestinal involvement and, as described in the latest publications, may include topical or systemic corticosteroids, oral metronidazole, antibiotics, azathioprine, infliximab, adalimumab, and even surgery [18–21,22 ▪▪ ]. Surgery is generally reserved for lesions refractory to medical treatment or those that require debridement, drainage, or excision [18–21,22 ▪▪ ]. For patients with isolated metastatic Crohn's without gastrointestinal disease, topical or intralesional corticosteroids alone may be an adequate first line treatment [20,22 ▪▪ ].…”