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Hidradenitis suppurativa is a common condition that can be disabling and warrants early recognition and multimodal treatment.
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The vulvar lesions of metastatic Crohn disease present with a range of clinical findings and can precede the diagnosis of gastrointestinal symptoms by months to years.
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Aphthous ulcers are a clinical diagnosis of exclusion and can be classified as primary or secondary to systemic disease.
Challenging Ulcerative Vulvar Conditions: Hidradenitis Suppurativa, Crohn Disease, and Aphthous Ulcers
Section snippets
Key points
Hidradenitis suppurativa
Hidradenitis suppurativa (HS), also known as acne inversa, and historically as Verneuil's disease, is a common, chronic, disabling disease that unfortunately is often misdiagnosed and undertreated.1 HS is an inflammatory cutaneous disease localized to intertriginous areas, including axillary, inguinal, anogenital, and inframammary skin. It is characterized by acute, recurrent, painful cysts and draining nodules, as well as chronic secondary scarring, dyspigmentation, and fistula formation.2 The
Metastatic Crohn disease of the vulva
CD has classically been viewed as a chronic inflammatory bowel disease that is characterized by segmental noncaseating granulomas and may affect any portion of the gastrointestinal (GI) tract, from the mouth to the anus. The current paradigm has broadened the view of this disease to a multisystem inflammatory disorder with the potential to affect multiple organs, including the skin.62
CD usually begins during the second or third decade of life and has a slight female predominance. GI CD commonly
Vulvar aphthous ulcers
Aphthae are painful, shallow ulcers that commonly occur on the oral mucosa and less commonly occur on the genital mucosa. The etiology of aphthae is unclear, but risk factors include stress, infections, hormonal factors, vitamin deficiency, and family history.75 The diagnosis of complex aphthosis is challenging for the clinician, because it is a clinical diagnosis of exclusion, and is complicated generally by the broad differential diagnosis of genital ulcers. Moreover, it is frequently missed
Acknowledgments
The author gratefully acknowledges the substantial contribution of Kristin D. Thompson in preparing and editing this article.
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Cited by (6)
Hidradenitis Suppurativa Differential Diagnosis and Mimickers
2022, A Comprehensive Guide to Hidradenitis SuppurativaGenital ulcer disease – A review for primary care providers caring for adolescents
2020, Current Problems in Pediatric and Adolescent Health CareCitation Excerpt :Fungal infections, such as candidiasis, may also generate genital ulcers.15,20 These genital ulcers due to non-STI infections may be categorized within the complex, secondary aphthous ulcers noted below in some reviews.11,20–22 Non-infectious causes of genital ulcers can be categorized as due to trauma, neoplasia, bullous and non-bullous dermatoses, as well as drug and hormone reactions and sensitivities.
Inflammatory Diseases of the Vulva
2020, Gynecologic Pathology, Second EditionVulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment
2024, Journal of Lower Genital Tract DiseaseManaging metastatic Crohn’s disease: a single center experience, review of the current evidence, and treatment algorithm
2023, Scandinavian Journal of GastroenterologyVulvar hidradenitis suppurativa: Clinical cross-sectional study of 25 patients
2021, Journal of Dermatology
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