(iii) Stevens–Johnson syndrome (iv) Scarlet fever (v) Viral infections (f) Skin conditions (i) Atopic dermatitis (ii) Contact dermatitis (iii) Lichen sclerosis Other causes of vaginal complaints in the prepubertal child include cervical polyps and tumors, systemic illnesses such as Kawasaki disease, Stevens–Johnson syndrome, and Crohn’s, certain infectious diseases including scarlet fever and some viral illnesses, parasitic diseases such as pinworms, and skin diseases such as atopic dermatitis, contact dermatitis, and lichen sclerosis Examination In the prepubertal patient, examination begins with a general physical examination Examination of the prepubertal patient should be performed in the presence of a parent or caregiver Explaining what will occur during the examination helps to alleviate anxiety surrounding the exam in some children Provide a gown or drape when possible Examination of the external genitalia is often best accomplished by having the infant or child lie supine in the frog-leg position The child’s parent or caregiver can assist by placing the child on his or her lap or between the parent’s legs on the examining table If the patient is unable to tolerate this position, an alternate position for examination can be obtained by having the patient lie prone in the knee to chest position The examination should include inspection of the perineal area, vulva, and vaginal introitus Specimen testing can be obtained by using a cotton-tipped swab moistened with sterile nonbacteriostatic saline or swabs provided in PCR testing kits Diagnostic Testing and Treatment In the majority of prepubertal girls who present with vaginal discharge, no specific etiology can be found Treatment of nonspecific vaginitis includes