Pruritus vulvae in prepubertal children.

BACKGROUND: Vulvar pruritus is a common complaint in females of all ages. However, little has been published on pruritus vulvae in children as a primary symptom. OBJECTIVE: Our purpose is to review the causes and treatments of vulvar pruritus in prepubertal girls and to retrospectively evaluate the causes and outcomes of the premenarchal children we studied. METHODS: The records of 44 premenarchal girls with vulvar pruritus were reviewed, and follow-up interviews were performed by telephone. RESULTS: Thirty-three patients (75%) had nonspecific pruritus. Lichen sclerosus, bacterial infections, yeast infection, and pinworm infestation were seen in a minority of patients. At follow-up, pruritus had cleared in 15 patients, been alleviated in 13, and remained the same in 4. CONCLUSION: Most of our patients had nonspecific pruritus, which was alleviated by or cleared with better hygiene and avoidance of irritants. In prepubertal girls, poor hygiene and irritants such as soap are major contributors to pruritus vulvae. All patients may benefit from following hygienic measures and irritant precautions in addition to specific therapy directed at underlying causes.

Idiopathic calcinosis cutis presenting as labial lesions in children: report of two cases with literature review.

BACKGROUND: Calcinosis cutis is a general term for calcium deposition in the skin. It may be due to abnormal calcium or phosphorus metabolism, damage to the dermal collagen, or idiopathic. It has been found in the skin of many areas of the body, including the face, extremities, penis, scrotum and mons pubis. We report two cases of calcinosis cutis presenting as lesions of the labia majora in children. CASES: A 6 1/2-year-old girl presented with labial lesions of unknown etiology. There was no history of sexual abuse or trauma. Excisional biopsy was performed and histopathological evaluation showed subepithelial calcification. Follow-up laboratory evaluation revealed normal serum calcium and phosphorus levels. Screening tests for collagen vascular diseases were negative. An 8-year-old girl presented for evaluation of a "labial cyst." The lesion was first noted 6 months prior to presentation and had not resolved, despite treatment with topical creams and sitz baths. Excisional biopsy was performed and histopathological evaluation showed multiple nodules of calcified and amorphous debris surrounded by histiocytes and giant cells. CONCLUSION: We report two cases of idiopathic calcinosis cutis presenting as labial lesions in children. Because it can be mistaken for a sexually transmitted disease, recognition and proper diagnosis of this condition is essential. Additionally, work-up to rule out abnormalities of phosphorus or calcium metabolism and collagen vascular diseases may be indicated.

Evaluation of vaginal bleeding in the preadolescent child.

Vaginal bleeding in a prepubertal child is always a serious medical concern. Vaginal bleeding in this age group may result from estrogen stimulation, which is more likely to be pathological than physiological, infections, tumors of the lower genital tract, ovarian tumors, foreign bodies, or trauma. Evaluation and management of the prepubertal child requires an understanding of the techniques of the physical examination, comprehension of the normal prepubertal unestrogenized anatomy, and indications for a more comprehensive examination under anesthesia. Caution should be exercised by the clinician so that the physical examination and workup do not further traumatize the child.

Crohn's disease of the vulva.

Ulcerative lesions of the vulva have multiple etiologies. A systemic illness is not often considered in the differential diagnosis. This patient with Crohn's disease presented with vulvar lesions 3 years prior to the manifestation of her complaints and definite diagnosis. A brief review of the literature is also presented.