Vulvar Ulcers in Children Dramatic But Self-Limited

Objective We aimed to describe our experience in diagnosing and managing Lipschutz ulcers in children. Methods This was a retrospective data review in a tertiary referral clinic for pediatric and adolescent gynecology. We identified patients referred with a vulval ulcer and recorded relating symptoms, presentation, and resolution. Results We identified 7 nonsexually active girls with vulvar ulcers presenting within the course of an upper respiratory infection, including fever and cough. Average age was 12.25 years (range, 11-14.5 years). All patients presented with at least one large painful ulcer within the inner surface of the labium minor, of up to 2 cm in diameter. Initial presentation was of a bullous lesion that was then ulcerated, covered by a black gangrenous scab. Over the course of the week, the scab fell leaving a white-based ulcer that gradually healed. All children complained of dysuria stemming from contact irritation with urine. The ulcer gradually disappeared, leaving no mark within 10 days of initial presentation. Two of 7 patients presented with 3 similar recurrences after flu-like symptoms. None of the patients qualified for diagnosis of Behcet disease. Conclusions Lipschutz ulcers are painful genital lesions causing anxiety to the girl and her family. Pediatricians and gynecologists should be aware of the condition, diagnose it where appropriate, avoid unnecessary medication, and reassure the patient that it is self-limited.