Dermatologists: Need help for pediatric genital irritation of unknown cause!?
My prepubescent daughter has had genital exasperation for 6 months. She has undergone the innumerable of treatments from multiform doctors though resolution. Some days she can hardly mount to lay or wear underwear. There have been no manifest signs solely red vaginal mucosa (hymen is intact), as well as the redness continues in the true line up the moment of her hiney during times. No manifest vaginal liberate or odor. The customarily things which assistance have been baths or showers twice every day with no soap as well as accepted steroids which we make make use of of sparingly. She has been treated with colour with mebendazole (pinworm) twice with no effect, so which was ruled out. Two cultures showed normal germ inhabitance. We practical medication antifungal creams (Protonix, Vusion, nystatin) to no avail. She has had dual doses of verbal antifungal (fluconazole) with no difference. We make make use of of All Free/Clear detergent, string white underwear, as well as white toilet tissue. She is entirely potty trained. What differential diagnosis am we missing? Thank we in advance!
I forgot to discuss we’ve attempted Premarin (estrogen) thickk cream though we practical it unequivocally sparingly for customarily about the week as well as afterwards haphazardly thereafter. we did not see any effect. Any alternative thoughts we might have would be severely appreciated.
Also she had the red blood exam to order out allergy to usual food allergens (eggs soy, milk, corn), all negative.
We’ve additionally attempted benadryl, claritin, as well as zyrtec. They marked down the night exasperation though not the altogether problem. My regard with which is which it customarily somewhat masks the symptoms, though doesnt heal the problem. Plus, during times, the exasperation is VERY severe. Again, she can’t lay or even mount to wear underwear. Now which the continue is removing colder as well as we can’t put her in dresses we do not know what I’m starting to do. She is pang with this. I’m fearful we can’t only relax as well as omit it.
Thank we all for your serve insights. To answer your questions, she only incited 4 years old. we dont see any unfamiliar physique as well as her hymen is intact. we am as certain as any one can be which there is no passionate abuse concerned as we am with her twenty-four hours the day when she is not in preschool 2 days per week, as well as we have ruled out any inapt hit during propagandize since during times she’s been off from propagandize for the week as well as the half as well as her symptoms have stayed the same or exacerbated. There is no bleeding, discharge, blisters, or calculable lesions. Just the vaginal mucosa is red as well as if we do not give her the bath or showering for 48 hours the redness extends as the prosaic skinny line up to the tip of her bum crack. She has additionally had the urine representation – negative. Also to desribe the exasperation – it is not itching, per se, though rsther than irritation/ pain. When the symptoms have been bad it involves both the vaginal as well as anal area. She doesn’t blemish most though the vigour of sitting or wearing garments hurts her.
… to the indicate of her crying. For example, upon the bad day, when she’s put in her carseat as well as the weight of her physique is focused upon her bottom, she will protest as well as cry. Right right away we can keep it in check with once or twice every day showers (no soap), plus/minues the little bit of accepted triamcinolone upon the misfortune days. Even afterwards she is still unequivocally worried by it. I’ve additionally beheld which before to the bowel transformation she will have increasing complaints, which creates me think which the exasperation extends inside the anus, nonetheless the anus customarily appears normal externally.
Sorry for the extensive post. we unequivocally conclude all your insights as well as acquire more. She has the dermatologist appt upon Thursday though he has already endorsed she take 2 some-more courses (weekly) of fluconazole, so we would similar to to go there armed with your consultant suggestions. Thank we unequivocally most in advance!
Sorry, we meant to contend she is in preschool dual days the week.
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Comments
very good thorough history. Its obviously vaginitis so just have to find the cause. Did they do any swabs? if she’s having yeast,the fluconazole would’ve eliminated it so we can rule that out. Do not use too much steroids. and 6 months already means its chronic inflammation. How old is your child? Perhaps she had entered a foreign body into her vagina which has gone undetected? Is there any bleeding or any other multisystem symptoms? whats her WBC count like?
I suggest a cervical/vaginal swab and CT scan if possible. (if bleeding is positive, then an MRI might be necessary to rule out any soft tissue masses) Its quite impossible to make a diagnosis without some interaction.
P.S.
She has to stop scratching it even if its itchy. Scratching will further progress the inflammation and spread of infection. Try to use some aloevera gel to soothe the itch and inflammation.
Not a dermatologist, but have you had her estrogen levels checked? If it is abnormal, there is a local estrogen tablet, vagifem, that can help. I know that sounds really weird, but I had similar symptoms and the treatment sounds similar to what I had.
I suppose you have tried everything under the sun….. Do one thing start her on antihistamines 2 times daily… even benadryl would do. Start applying moisturisers on that areas 3-4 times a day. Stop all the other treatment. When we try out lots of stuff we miss on the most simplest of things. Dont worry… stress itself can cause itching and if your daughte scratches that area it will always look red. so just relax and relax your daughter also. Anti histamines and moisturisers should works.
If you have tried even antihistamines….. The only thing left may be is a punch biopsy… to see what the irritation is… Are there any blisters? Are there any irritation free days? How old is she?
See.. it doesnt seem to be any fungal infection, any worm infestations, No baterial infections, What about viral? Herpes…I know it would not continuously last so long.
Contact dermatitis…. well you have been careful.
Scabies…. other body parts would be involved.
Any urinary tract infections? Is your child a happy child? depression/ anxiety/ sibling rivalry all such aspects need to probed into…. I am just thinking what else it would be. Being a dematologist I am quite intrigued by the complaints and the treatment. I think you should continue the antihistamines. stop steroids for a week or so and if need be meet a dermatologist and consider a skin biopsy. If that is normal then you have nothing to worry about.
http://www.nlm.nih.gov/medlineplus/ency/article/003159.htm
http://www.wrongdiagnosis.com/sym/vaginal_itching.htm
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