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Vulval Aphthosis — SCE Dermatology MCQ

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HardGenital DermatologyVulval AphthosisSCE Dermatology

A 28-year-old woman presents with recurrent genital ulceration. She has deep painful ulcers on the labia minora with ragged undermined edges. She has no oral ulcers or eye disease. All microbiological investigations including HSV PCR, syphilis serology, and Behçet screening are negative. Biopsy shows non-specific chronic inflammation. What is the most likely diagnosis?

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Correct answer: D — Vulval aphthosis (complex aphthosis)

Vulval aphthosis (complex aphthosis) presents with recurrent painful genital ulcers in the absence of Behçet disease. The ulcers are idiopathic and may be deep with undermined edges. Diagnosis is one of exclusion after ruling out infection (HSV, syphilis, chancroid), Behçet disease, Crohn disease, and other causes. Lipschütz ulcers (ulcus vulvae acutum) typically occur in adolescent girls as acute, large, self-limiting vulval ulcers often following febrile illness. Complex aphthosis is managed with topical corticosteroids, Colchicine, Dapsone, or immunosuppressants for recurrent disease.

Reference: BASHH 2014 Vulval Ulcer Guidelines; BAD