Mini-Puberty of Infancy in Extreme Prematurity

the patient was found to have extensive vulvar erythema and swelling associated with bullous lesions and desquamation that was causing significant pain (Figure 1a).Differential diagnosis included: Steven-Johnson syndrome, scalded skin syndrome, herpes simplex virus, ebstein-barr virus, exfoliative dermatitis, vulvar cellulitis, and contact dermatitis.She was admitted to the hospital for further evaluation and symptomatic management.After exploration of the differential diagnosis and after further history was revealed, the patient was ultimately diagnosed with irritant contact dermatitis with a suspected superimposed bacterial infection.The contact irritant was suspected to be sanitary wipes used to obtain a clean catch urine sample in the week prior to presentation.She was treated with a course of antibiotics as well as topical steroids and topical lidocaine.The patient was seen in the outpatient setting 2 weeks following discharge and was noted to have almost complete resolution of her vulvar dermatitis (Figure 1b).Comments: This case is a model demonstration of the confusing clinical picture that often accompanies a diagnosis of vulvar dermatitis in the adolescent patient.Additionally, vulvar dermatitis is often a diagnosis of exclusion and this case provides a strong example of the evaluation of some of the less common causes of vulvar dermatoses.A better understanding of the pathophysiology and clinical presentations of vulvar dermatitis is required to allow for prompt diagnosis, treatment, and prevention.This is especially true in the pediatric/adolescent gynecology field as vulvar dermatoses are commonly the chief complaint of office visits.