The Yeast (Infection) That Won't Cease
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Joe R. Monroe, MPAS, PA, ­practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Phyisican Assistants.

An 8-year-old's stubborn "yeast infection" has her primary care provider stumped; every attempt at treatment has failed. See if your assessment can clear up the problem.

Question 1 of 1

The Yeast (Infection) That Won't Cease image
About a year ago, an otherwise healthy 8-year-old girl developed itching and discomfort in the perivaginal and perianal areas that persists despite use of anti-yeast creams (nystatin, clotrimazole) and OTC hydrocortisone 1%. It was diagnosed as a yeast infection, but the patient was referred to dermatology when all treatment attempts failed.

A well-defined, figure-8 pattern of white, atrophic skin surrounds the vaginal and perianal areas. Erosions can be seen on the more atrophic areas of the labia, along with faint patches of telangiectasias. The urethra is uninvolved, as is the immediate perianal skin.

A punch biopsy is obtained; it shows hyperkeratosis, epidermal atrophy, and scleroderma with a lymphocytic infiltrate.

The most likely diagnosis is

Resistant yeast infection

Fungal infection

Lichen sclerosus


Clinician Reviews. 2018 March;28(3):8

This quiz is not accredited for CME.