Vulval Crohn disease: A case series of 26 patients

Abstract

Vulval Crohn disease is rare and likely under‐reported, leading to difficulty in diagnosis and delay in treatment. In this case series, we report the clinical features and discuss therapy in 26 consecutive patients with vulval Crohn disease, with or without documented gastrointestinal disease, presenting between January 2016 and July 2018. We highlight the need for treatment that is in some cases more aggressive than the requirement to manage the patient's gastrointestinal involvement.

Metastatic Vulval Crohn’s Disease With Good Outcome on Ustekinumab

“…Furthermore, longterm metronidazole is associated with peripheral neuropathy, which can limit its continued use [13]. With the advent of biological agents, several studies have reported excellent outcomes with infliximab and azathioprine [3,4,[6][7][8][9][10][11][12][13][14][15] among others like ustekinumab, which have shown rapid resolution of symptoms similar to the outcome in our patient [15].…”

“…A case series from a private vulval centre included patients without histological diagnosis and treated them similarly. However, they reported good outcomes with the treatment [ 10 ].…”

“…Treatment of vulval Crohn’s disease is not different from standard regimes [ 3 , 4 , 6 - 8 , 10 , 12 ]. Metronidazole with or without adjunctive steroids has shown to be effective for many cases; however, disease recurrence, with some reporting exacerbation after sudden cessation of treatment, is an issue [ 8 ].…”

Vulvar Crohn's Disease: Clinical Features and Outcomes

“…Less commonly, genital involvement occurs, as in vulvar CD (2). Vulvar CD has been described in case reports and case series, but larger studies including descriptions of possible therapies are limited (2)(3)(4)(5)(6)(7)(8)(9). Vulvar involvement may not parallel intestinal involvement.…”

“…In a review article, vulvar symptoms were reported to precede gastrointestinal (GI) symptoms in up to 25% of patients (3). Reported signs and symptoms of vulvar CD include characteristic knife-like ulcerations, pelvic pain including dyspareunia, pruritus, and vulvar edema (4,5). Biopsies can show granulomas and less specific findings, such as perivascular infiltrates (4).…”