Vulval Crohn’s Disease in Childhood

Abstract

Vulval involvement in Crohn’s disease (CD) is rare, particularly in children. The clinical features include erythema, edema, ulceration, and labial skin tags. The authors present two cases of children with vulval CD. In both cases, marked labial edema was the presenting feature. In one patient the immunomodulator tacrolimus ointment 0.03% was used with success. In the second patient control was achieved with intralesional triamcinolone in combination with systemic metronidazole.

Vulvar swelling as the first presentation of Crohn's disease in children—A report of three cases

“…Vulvar biopsy reveals chronic inflammatory changes with noncaseating granulomatous inflammation. Differential diagnoses to consider include cellulitis, pyogenic infections, hidradenitis suppurativa, sarcoidosis, tuberculosis, foreign body reactions, contact dermatitis, acquired lymphangiectasia, and sexual abuse . Metastatic Crohn's disease in children is rare—a literature review in 2009 found 28 individual case reports spanning 40 years, with genital Crohn's disease accounting for 21 of the 28 cases .…”

“…Evidence of optimal management is limited and usually involves medical management of underlying Crohn's disease. Regimens used include metronidazole, azathioprine, methotrexate, oral and topical steroids, and tumor necrosis factor‐alpha inhibitors such as infliximab and adalimumab . Other agents such as 6‐mercaptopurine, sulfasalazine, and ciclosporin have also been used .…”

“…Regimens used include metronidazole, azathioprine, methotrexate, oral and topical steroids, and tumor necrosis factor-alpha inhibitors such as infliximab and adalimumab. 2,5,6 Other agents such as 6-mercaptopurine, sulfasalazine, and ciclosporin have also been used. 2,5,6 Most studies report significant improvement with metronidazole alone or in conjunction with oral or topical steroids.…”

“…Metastatic Crohn's disease is characterized by granulomatous disease usually separate from and unlinked to gastrointestinal involvement and includes genital Crohn's disease. Vulvar swelling is a rare manifestation of metastatic genital Crohn's disease in children, with isolated case reports in the literature . We describe three cases of Crohn's disease in children presenting with vulvar swelling and propose that, in these patients, a high index of suspicion for Crohn's disease is required, even in the absence of gastrointestinal symptoms.…”

“…Vulvar swelling is a rare manifestation of metastatic genital Crohn's disease in children, with isolated case reports in the literature. [2][3][4] We describe three cases of Crohn's disease in children presenting with vulvar swelling and propose that, in these patients, a high index of suspicion for Crohn's disease is required, even in the absence of gastrointestinal symptoms.…”