Understanding and Managing Vulvar Psoriasis in Girls: Findings From a Cohort Study.

Abstract

Background/objectives: Pediatric vulvar psoriasis in girls is under-recognized and under-treated due to its nonspecific clinical appearance. This paper aims to describe the signs and symptoms of pediatric vulvar psoriasis and treatment strategies used by our group.

Methods: A retrospective cohort study was undertaken at a private pediatric dermatology referral practice from January 2016 to December 2022. Clinical data were prospectively collected and recorded in an online patient database. Treatment regimens were individualized and titrated to clinical response.

Results: In 100 girls with vulvar psoriasis, the most common presentation was an erythematous vulvar eruption (97%) which was well-demarcated in 52% of children and appeared as a plaque in one-fourth. The perianal skin was involved in 48% of cases. Extragenital psoriasis was present in 69% of patients. Most children responded to initial induction treatment with moderate-potency topical corticosteroid ointment followed by maintenance with topical tar solution. Systemic treatment was not required for purely vulvar psoriasis compared with 3% of children with extragenital psoriasis.

Conclusion: Vulvar psoriasis in girls presents as a chronic erythematous vulvitis, with perianal involvement in half the cases, but without vaginitis. It is a remitting and relapsing skin condition that requires long-term topical management.