title: Vulval Crohn's disease: a clinical study of 22 patients.
abstract: Vulval Crohn's disease [VCD] is a challenging condition that can occur without gastrointestinal Crohn's disease [GCD]. We reviewed the clinical features and effects of therapy in a cohort of 22 patients with VCD to determine whether the presence of GCD affected the clinical presentation and treatment response. Of these, 64% had GCD and 65% of these presented with GCD prior to VCD. Fissuring, ulceration, and scarring were more common in those with VCD alone. Potent and ultra-potent topical steroids showed benefit in most patients. There was no clear evidence of sustained remission with metronidazole. Azathioprine was the most commonly used oral immunosuppressive agent, with an efficacy of 57%. Patients with both VCD and GCD had a better clinical response compared with those with VCD alone [70% and 25%, respectively]. Infliximab and adalimumab were effective in 56% and 71% of patients, respectively. Excision of redundant tissue was helpful in four patients. The absence of GCD may delay the diagnosis in women who present with vulval symptoms alone. The more active clinical features in those with VCD alone may represent a more aggressive condition, or the severity of the cutaneous disease may have been reduced by immunosuppression taken for GCD. Several patients obtained sustained remission in their GCD with anti-tumor necrosis factor alpha [anti-TNFα] agents while the VCD remained active.
authors: Department of Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK zainablaftah@nhs.net.
authors: Zainab
authors: Z
authors: Laftah
authors: Department of Dermatology, Chelsea & Westminster Hospital, London, UK.
authors: Clare
authors: C
authors: Bailey
authors: Department of Dermatology, Imperial College NHS Healthcare Trust, London, UK.
authors: Shirin
authors: S
authors: Zaheri
authors: Department of Dermatology, Imperial College NHS Healthcare Trust, London, UK.
authors: Jane
authors: J
authors: Setterfield
authors: Department of Dermatology, Chelsea & Westminster Hospital, London, UK.
authors: Lucinda Claire
authors: LC
authors: Fuller
authors: Department of Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK.
authors: Fiona
authors: F
authors: Lewis
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014844:Vulva / Q000473:pathology*; D014845:Vulvar Diseases / Q000188:drug therapy / Q000209:etiology*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D001379:Azathioprine; D008727:Methotrexate
keywords: Crohn’s disease; gastrointestinal Crohn’s disease; vulval Crohn’s disease