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Chronic vulvitis in pre-pubertal girls.

Gayle Fischer¹

¹Department of Dermatology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia. gayle.fischer@sydney.edu.au

The Australasian Journal of Dermatology

|June 16, 2010

Summary

Chronic vulvitis in pre-pubertal girls is often misdiagnosed as candidiasis. This study found psoriasis or atopic dermatitis are the likely causes, not fungal infections.

Area of Science:

Dermatology
Pediatric Gynecology
Infectious Diseases

Background:

Pre-pubertal girls with chronic vulval inflammation are frequently diagnosed with non-specific vulvovaginitis.
Previous diagnoses often incorrectly attribute symptoms to candidiasis.
The role of Candida in pediatric vulvitis requires clarification.

Purpose of the Study:

To investigate the etiology of chronic vulvovaginitis in pre-pubertal girls (Tanner Stage 1).
To specifically assess the prevalence and causal role of candidiasis in this age group.
To compare findings with post-menarchal adolescents and pre-menopausal women.

Main Methods:

Retrospective case series analyzing charts of 38 pre-pubertal girls and 68 adults with chronic vulvitis.
Review of previous diagnoses, treatments, and microbiological testing results.

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Clinical skin examination for dermatological conditions like psoriasis and atopic dermatitis.

Main Results:

50% of pre-pubertal girls had prior candidiasis diagnoses, yet only 5% yielded positive Candida cultures.
No pre-pubertal girls showed a causal association between Candida and vulvitis, unlike 54% of adults.
Psoriasis (71%) and atopic dermatitis (24%) were prevalent in pre-pubertal girls; symptoms improved with anti-inflammatory treatment.

Conclusions:

Chronic vulvovaginal candidiasis is not a feature of Tanner Stage 1 girls.
Psoriasis and atopic dermatitis are the primary causes of chronic vulvitis in pre-pubertal girls.
Diagnosis should focus on dermatological conditions, and antifungal treatments should be reconsidered.