Vulval Crohn’s Disease in Childhood
A 13-year-old girl presented with a 9-month history of asymptomatic vulval swelling. The patient was diagnosed with CD at the age of 5 years and had been well-controlled on methotrexate. Physical examination revealed a healthy-looking girl. Examination of the vulva demonstrated asymmetrical dusky-colored edematous skin with a “peau d’orange” appearance. Examination of the peri-anal skin showed fissures and skin tags (Fig. ). Examination of the rest of the skin, oral mucosa, and other systems was unremarkable. Biopsy of the affected vulval area showed typical features of non-caseating granulomata with negative stains and culture for organisms. The patient was treated with intralesional triamcinolone and oral metronidazole, which resulted in a clear improvement in terms of swelling after 3 months.