A 13 year old girl was evaluated for persistent nontender indurated erythema of the labia. She had been treated with multiple topical antibiotics, antifungals, steroids, and lubricants without improvement. Multiple cultures were negative for bacterial, viral and fungal organisms. She was otherwise healthy with normal growth and development. On further questioning she admitted to occasional episodes of diarrhea but no bloody stools. A punch biopsy from the right labia majora showed granulomatous inflammation, and endoscopy demonstrated distal colonic Crohn disease. Although the bowel disease improved within 1 month of starting therapy, cutaneous lesions required almost a year to resolve.
woody indurated plaques on labia, scar on right labia from biopsy