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Perivulvar Pseudoverrucous Papules and Nodules in a 4-Year-Old Girl with Urinary and Fecal Incontinence: Case Report
Robert P Kauffman1, Shazma M Khan2, Lois Mendez2
1Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas.
Insights
Pseudoverrucous papules and nodules, a rare complication of irritative diaper dermatitis, can mimic other conditions. Early recognition in incontinent children is key to appropriate management and avoiding misdiagnosis.
Area of Science:
- Pediatric Dermatology
- Clinical Pathology
Background:
- Diaper (irritative) dermatitis is a common pediatric condition.
- Severe cases can present with lesions mimicking other vulvar dermatoses or infections.
Observation:
- A 4-year-old female refugee with urinary and fecal incontinence presented with diffuse vulvar, perineal, and perianal lesions.
- These lesions were evaluated and histologically confirmed as pseudoverrucous papules and nodules.
Findings:
- Pseudoverrucous papules and nodules represent a rare complication of irritative diaper dermatitis.
- Urinary or fecal incontinence are significant risk factors for developing these atypical lesions.
Implications:
- Clinicians should suspect pseudoverrucous papules and nodules in incontinent children with atypical genital or buttocks lesions.
- While biopsy may not always be necessary, it can be warranted for diagnostic uncertainty or concerns of abuse.
Background:
Diaper (irritative) dermatitis is commonly encountered in pediatric practice. In severe cases, unusual lesions could mimic other vulvar dermatoses or sexually transmitted infections.
Case:
A 4-year-old female refugee with urinary and fecal incontinence was referred for medicolegal evaluation (concern for childhood sexual abuse) due to presence of diffuse vulvar, perineal, and perianal lesions. Evaluation and histology were consistent with pseudoverrucous papules and nodules. Resolution occurred following frequent diaper changes and application of a protective ointment.
Discussion:
Pseudoverrucous papules and nodules are a rare complication of irritative diaper dermatitis with variable appearance. Urinary or fecal incontinence are primary risk factors that should raise suspicion among clinicians when atypical genital or buttocks lesions appear. Biopsy is not always necessary but could be warranted when the diagnosis is uncertain or if childhood sexual abuse is suspected.
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