White Vulvar Plaques in an Eight-Year-Old Girl

An 8-year-old girl presented to the pediatric dermatology clinic with her mother with a chief concern of a pruritic rash located on the genitalia that has been worsening, on and off, for 7 years.

History. The patient’s mother states that the patient has had occasional bouts of constipation but no urinary tract infections. The mother tried applying 2.5% hydrocortisone with no apparent improvement and has recently been cleansing the area with just water. Upon presentation, the patient was in no acute distress and appeared well developed, well nourished, alert, and oriented. Glistening white atrophic papules with telangiectasia, purpura, and clitoral hood edema were observed on the vulva and perianal skin. The remainder of the physical examination was unremarkable.

Diagnostic testing. No laboratory tests were obtained, and a clinical diagnosis was made.