Highlights of the Society for Pediatric Dermatology Annual Meeting

July 6-9, 2006; Montreal, Quebec, Canada

Brandie J. Metz, MD

Disclosures

November 30, 2006

In This Article

Vulvar Diseases in Children

Deana Funaro, MD, from Hôpital Ste-Justine in Montreal, Canada, spoke about vulvar diseases in children.[1] Determining the etiology of genital ulceration in young girls and adolescent females can be very challenging. In adult women, the top 5 causes of genital ulceration are herpes simplex virus (HSV), erosive candidiasis, erosive lichen planus (LP), lichen sclerosis et atrophicus (LS et A), and aphthosis. Little is known about these conditions in the pediatric population, however. The list of causes of vulvar diseases in children includes some of the same conditions (aphthosis, HSV), but also includes autoimmune diseases such as Crohn's disease and Behcet's syndrome. Genital ulcers in girls may also be caused by other infectious agents, such as Epstein-Barr virus (EBV) and Mycoplasma. Genital ulceration also has been reported as a presenting manifestation of infectious mononucleosis.[2] The diagnosis of an EBV genital ulcer can be difficult to confirm because, according to Dr. Funaro, a Monospot test can be negative in up to 50% of children. Diagnosis can be made by measuring serum antibodies, specifically EBV IgM. EBV can also be demonstrated by PCR. Lesions tend to heal in 1 to 4 weeks. Treatment is supportive, and the ulcers do not tend to recur.

Dr. Funaro recommends that physicians avoid empiric treatment of genital ulcers in children, but rather attempt to reach a diagnosis and treat accordingly. The history should include a sexual history and a history of sexually transmitted diseases. Bacterial and viral cultures should be performed. Blood tests that may be helpful include HSV and EBV serologies, and, in the case of complex aphthosis, determination of iron, folate, zinc, and vitamin B12 levels. A complete blood count should also be obtained, because cyclic neutropenia can cause genital ulcers. Biopsies may be helpful to exclude some diagnoses but are not always diagnostic.

Dr. Funaro emphasized the important concept that in the case of lichen simplex chronicus (LSC), it is important to reexamine the patient after treatment, because LSC can mask the presence of underlying pruritic vulvar disease such as LS et A or psoriasis.

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