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The paediatrician and the management of common gynaecological conditions
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  • Published on:
    Response to e-letter entitled: Importance of dermatology in paediatric vulval disease
    • Joanne Ritchie, Dr Department of Obstetrics and Gynaecology, Shrewsbury and Telford NHS Trust, Princess Royal Hospital, Telford TF1 6TF, UK


    Thank you for the opportunity to reply, here is our response.

    We would like to thank the authors for their valuable comments, we believe that these comments add to and complement our article. Our article aimed to cover a wide breadth of common gynaecological conditions that can affect children and unfortunately we were therefore not able to go in to great detail for each condition covered. We would certainly agree on the importance of an early diagnosis for lichen sclerosus and collaboration with a dermatologist for treatment if available. The British Association of Dermatologists guidelines for the management of lichen sclerosus was not published when we wrote our article, we can see that this is a very valuable resource.

    Kind Regards

    Jo Ritchie

    Conflict of Interest:
    None declared.
  • Published on:
    Importance of dermatology in paediatric vulval disease
    • Fiona M Lewis, Consultant Dermatologist St John's Institute of Dermatology, Guy's & St Thomas' NHS Trust
    • Other Contributors:
      • Shireen S Velangi, Consultant Dermatologist
      • Saleem Taibjee, Consultant Dermatologist

    Dear Sir,

    We read with interest the review on ‘The paediatrician and the management of common gynaecological conditions’ (1). This is an important topic but we have concerns about incorrect information in this paper with respect to vulval disorders. Most vulval conditions are dermatological rather than gynaecological and the involvement of a dermatologist in the management of these children is vital. The breadth of paediatric vulval disease is not reflected in this paper including the concept of vulval presentation of various skin conditions (eg. psoriasis, chronic bullous dermatosis of childhood, erythema multiforme) and the need to examine the rest of the skin including the hair, nails and mucosa.

    There appears to be some confusion within the article, for example, a vaginal discharge is not a vulval disorder. While a discharge can lead to a vulvitis, the two problems of vaginitis and vulvitis should be distinguished as the investigation and management of each is very different.

    The commonest condition seen in children presenting with vulval symptoms is an irritant dermatitis which is not specifically mentioned in the section on vulval irritation. This is often seen in those with a background of atopy and requires emollients and a mild topical steroid application intermittently with good hygiene measures. Other important disorders such as Lipschutz ulcers and genital warts have been omitted.

    However, our major concerns relate to the section o...

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    Conflict of Interest:
    None declared.