Chronic vulvitis in pre‐pubertal girls

Pre‐pubertal girls with inflammatory chronic vulval disease excluding lichen sclerosus are often described as having ‘non‐specific vulvovaginitis’. The aim of this retrospective case series was to determine the aetiology of chronic vulvovaginitis in pre‐pubertal (Tanner Stage 1) girls, with particular reference to candidiasis. A chart review recorded and compared the characteristics of 38 girls and 68 post‐menarchal adolescents and pre‐menopausal women with chronic vulvitis. Nineteen (50%) of the pre‐pubertal children had been previously diagnosed with candidiasis and 21 (55%) had been treated unsuccessfully with topical antifungal agents. Candida albicans was isolated in two (5%) of the children and 37 (54%) of the adults (P < 0.001). A positive Candida culture was causally associated with chronic vulvovaginitis in 50% of the adults but in none of the children (P < 0.001). In 28 (74%) of the children and 28 (41%) of the adults, no pathogens were isolated on microbiological testing. General skin examination of the girls revealed signs of psoriasis in 27 (71%) and atopic dermatitis in nine (24%). Symptoms were controlled with topical anti‐inflammatory treatment and environmental modification, including cessation of topical antifungals. Pre‐pubertal girls with chronic vulvitis are likely to have either psoriasis or atopic dermatitis. Chronic vulvovaginal candidiasis is not seen in Tanner Stage 1 girls.