Vulvar Crohn’s—Case Series and Review of Treatment With Ustekinumab

Cutaneous vulvar Crohn’s disease (VCD) is a rare, diagnostically challenging condition requiring a patient-specific treatment approach. Biologic agents are emerging as effective targeted immunotherapies, with established evidence to support the efficacy of tumor necrosis factor (TNF)-alpha inhibitors and growing evidence for interleukin (IL) inhibitors, namely ustekinumab and risankizumab. IL inhibitors have shown promise in the treatment of refractory VCD cases requiring more targeted immunosuppression or after prior TNF-alpha inhibitor failure. Three cases of VCD managed by varying biologic agents are presented, in which ustekinumab achieved remission of symptoms in the first and risankizumab achieved control in the third. This series highlights the importance of assessing disease location and extent, immunosuppression risks, concurrent conditions, and treatment history to inform biologic selection.