Chronic vulvitis in pre-pubertal girls.
Pre-pubertal girls with inflammatory chronic vulval disease excluding lichen sclerosus are often described as having 'non-specific vulvovaginitis'. The aim of this retrospective case series was to determine the aetiology of chronic vulvovaginitis in pre-pubertal (Tanner Stage 1) girls, with particular reference to candidiasis. A chart review recorded and compared the characteristics of 38 girls and 68 post-menarchal adolescents and pre-menopausal women with chronic vulvitis. Nineteen (50%) of the pre-pubertal children had been previously diagnosed with candidiasis and 21 (55%) had been treated unsuccessfully with topical antifungal agents. Candida albicans was isolated in two (5%) of the children and 37 (54%) of the adults (P < 0.001). A positive Candida culture was causally associated with chronic vulvovaginitis in 50% of the adults but in none of the children (P < 0.001). In 28 (74%) of the children and 28 (41%) of the adults, no pathogens were isolated on microbiological testing. General skin examination of the girls revealed signs of psoriasis in 27 (71%) and atopic dermatitis in nine (24%). Symptoms were controlled with topical anti-inflammatory treatment and environmental modification, including cessation of topical antifungals. Pre-pubertal girls with chronic vulvitis are likely to have either psoriasis or atopic dermatitis. Chronic vulvovaginal candidiasis is not seen in Tanner Stage 1 girls.
Fischer
Gayle
G
Department of Dermatology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia. gayle.fischer@sydney.edu.au
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification; D002181:Candidiasis, Vulvovaginal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006194:Gardnerella vaginalis / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis / Q000628:therapy; D011627:Puberty; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome; D016585:Vaginosis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014847:Vulvitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents