A combination of local corticosteroid and petroleum ointment in managing labial adhesions in prepubertal female children: Should it be the first choice?

Background
Labial adhesion is a partial or complete adherence of the labia minora. It occurs in 0.6–5% of prepubertal females. Vulvar irritation in combination with hypoestrogenism is considered the main cause. Labial adhesions are often asymptomatic. Urinary or vulvar symptoms can occur. Topical estrogen therapy is the treatment of choice; however, it may cause adverse effects, such as breast budding, labial engorgement, and hyperpigmentation. Surgical separation is reserved for refractory cases. In the study, we aimed to evaluate the role of local corticosteroid in combination with petroleum ointment regarding efficacy, possible adverse effects, and incidence of recurrence.
Patients and methods
The study was conducted at the Pediatric Surgery Unit of Minia University Hospital from June 2019 to March 2021. All prepubertal female children who presented to the outpatient clinic with no history of previous management were included. According to the length of labial adhesion line (raphe), the severity of the condition was classified into four grades. Parents were instructed to care about local hygiene. Betamethasone 0.05% cream was applied as thin layer twice daily directly on the adhesion line with gentle pressure followed, after 2 h, by petroleum ointment (Vaseline). Patients were followed at the outpatients clinic. The first evaluation visit was after 2 weeks. In case of partial success, the same regimen was followed for another 2 or 4 weeks. Failure after 6 weeks was considered as indication for surgical separation. Successful cases were continued on petroleum ointment only for 1 month and followed up for 6 months.
Results
The study included 26 prepubertal female children with age ranging from 10 to 24 months. The commonest severity grade was grade III (46.2%). Success (complete separation) was achieved in 23 (88.5%) cases (eight cases after 2 weeks of local therapy, 13 cases after 4 weeks, and five cases after 6 weeks), whereas there was failure of complete separation in three (11.5%) cases after 6 weeks of local treatment, and they were managed by surgical separation. During post-treatment follow-up period, three cases were lost. Recurrence was reported in two (10%) cases out of the 20 cases that completed follow-up period, and they started the same regimen again with successful separation.
Conclusion
Use of local betamethasone cream in combination with local petroleum ointment in cases of prepubertal labial adhesions is considered as a good option regarding success rate, adverse effects, and recurrence.