OK well I found the image on
this medical site and this is what it says:
Figure 1: Asymmetrical vulvar edema with deep and linear ulcerations of the inguino-crural regions
SUMMARY: Bottom Line: A 46-year-old woman was diagnosed with a vulvo-perineal Crohn's disease without digestive involvement.Treatment with metronidazole (1 g/day for 6 months) led to almost complete healing of the ulcerations with a sustained result.Physicians must be aware of the diverse manifestations and confusing presentations of vulvo-perineal Crohn's disease.
Mentions: A 46-year-old woman, having in her past medical history chronic juvenile arthritis with bilateral prosthetic hips, presented with painful vulvo-perineal ulcerations of 3 years. There was no diarrhea or recent weight loss. Cutaneous examination showed asymmetrical vulvar edema of the labia minora and labia majora with deep and linear ulcerations having verrucous borders located on the inguino-crural regions [Figure 1] and the buttocks fold [Figure 2]. On physical examination there was bilateral limited mobilization of the hips. A biopsy specimen was taken from the border of the vulvar ulceration. Histological examination showed under an epidermal hyperplasia [Figure 3], an epithelioid granuloma of the dermis showing multinucleated giant cells without caseation [Figure 4]. Direct immunofluorescence on cutaneous biopsy was negative. Biology and chest X-ray were normal. Koch's bacillus in sputum, microbiological studies (staining for micro-organisms and cultures) and tuberculin testing were negative.
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