Differential Diagnosis for the 2-year-old Girl
- Single most likely diagnosis
- Labial adhesions: This condition is characterized by the fusion of the labia minora, which can cause urinary symptoms and is a common cause of genital abnormality in young girls. The patient's symptoms, including the appearance of the labia minora being thin and fused together at the midline, partially blocking the urethral meatus, and the presence of multiple excoriations, are consistent with this diagnosis.
- Other Likely diagnoses
- Lichen sclerosus: This is a chronic inflammatory skin condition that can cause thinning and fusion of the labia minora, as well as excoriations. It is a possible cause of the patient's symptoms, especially given the history of multiple diaper rashes.
- Vulvar dermatitis: This condition can cause inflammation and irritation of the vulvar area, leading to excoriations and discomfort. It is a possible cause of the patient's symptoms, especially given the history of multiple diaper rashes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Child abuse: Although the patient's symptoms do not strongly suggest child abuse, it is essential to consider this possibility, especially given the presence of excoriations and the abnormal appearance of the genital area.
- Urinary tract obstruction: The patient's symptoms, including the partial blockage of the urethral meatus, could potentially indicate a urinary tract obstruction, which would require prompt medical attention.
- Rare diagnoses
- Imperforate hymen: This is a rare congenital condition where the hymen is solid, rather than having an opening, which can cause urinary and menstrual symptoms. Although it is unlikely, it is essential to consider this possibility, especially if the patient's symptoms persist or worsen.
- Congenital adrenal hyperplasia: This is a rare genetic disorder that can cause virilization of female genitalia, including the labia minora. Although it is unlikely, it is essential to consider this possibility, especially if the patient's symptoms are accompanied by other signs of virilization.