Keratin pearls are intraepithelial accumulations of squamous cells and debris that can be an etiology of vulvovaginal irritation in pediatric patients and are often associated with clitoral adhesions. Historically, most cases have been managed with manual or operative lysis of adhesions.
Two prepubertal girls presented to our clinic with chronic clitoral irritation and were found to have clitoral adhesions with keratin pearls. Both were managed with topical estrogen cream, which resulted in resolution of their symptoms.
Summary and Conclusion
Keratin pearls can form when the overlying clitoral epithelium becomes blocked by clitoral adhesions. Hypoestrogenism is thought to be implicated in adhesion development; thus, topical estrogen cream is a reasonable option in initial management. Our results demonstrate a noninvasive alternative to the initial treatment of clitoral keratin pearls.
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Published online: October 06, 2022
Accepted: October 2, 2022
Received in revised form: September 22, 2022
Received: July 7, 2022
Publication stageIn Press Journal Pre-Proof
There was no source of funding for this study, nor do the authors have any financial interests to disclose.
Previously presented: (Poster Presentation) 33rd Annual North American Society for Pediatric and Adolescent Gynecology (NASPAG) Annual Clinical and Research Meeting. New Orleans, LA. April 2019.
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.