vulvar pruritus
Jump to navigation
Jump to search
Introduction
Intense itching of the female external genitalia
Etiology
- vulvovaginitis
- essential pruritus (localized neurodermatitis)
- lichen simplex chronicus
- lichen planus
- vulvar vestibulitis
- urinary tract infection
- atrophic vaginitis secondary to estrogen deprivation
- human papilloma virus (condylomata acuminata)
- vulvar carcinoma
- lichen sclerosus et atrophicus (LSA)
- seborrheic dermatitis
- fecal irritation secondary to fecal incontinence
- contact dermatitis
- parasitic infection
- crab lice
- pinworms
- scabies
- insect bites
- neurogenic/psychiatric
- Fox-Fordyce disease (apocrine sweat gland occlusion)
- systemic disorders
Clinical manifestations
- pruritus
- visible skin changes
- warts, tumors, ulcers & scaling
- vaginal or anal discharge
- colposcopic & histologic changes
Laboratory
- wet mount & KOH preparation of vaginal secretions
- biopsy of all suspicious lesions
- urinalysis & urine culture
- complete blood count
- scotch tape test
- chemistry panel
Diagnostic procedures
- colposcopy if indicated
- patch testing if indicated for allergies/contact dermatitis
Management
- acute vulvar pruritus
- chronic vulvar pruritus
- topical steroids
- 1-2.5 % hydrocortisone BID
- initial therapy with more potent steroid
- triamcinolone 0.025%
- fluocinolone 0.025%
- may be indicated; however, switch to hydrocortisone with improvement to avoid urogenital atrophy
- subcutaneous triamcinolone acetonide
- topical steroids
- Diet: avoid caffeine, peanuts, tomatoes
- patient education
- attention to good hygiene
- avoid tight-fitting clothes
- avoid irritants: douches, diaphragms, perfumed soaps, lotions, powders
- notify sexual partner & treat if indicated
- sitz baths (98 degrees F) with a few drops of water-dispersible oil
- CAUTION: pruritus is the most common presentation of vulvar carcinoma & vaginal cancer
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 398-99
- ↑ Stewart KM. Clinical care of vulvar pruritus, with emphasis on one common cause, lichen simplex chronicus. Dermatol Clin. 2010 Oct;28(4):669-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20883911
- ↑ Chibnall R. Vulvar pruritus and lichen simplex chronicus. Obstet Gynecol Clin North Am. 2017;44(3):379-388 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28778638 https://www.sciencedirect.com/science/article/abs/pii/S0889854517300700
- ↑ Savas JA, Pichardo RO. Female genital itch. Dermatol Clin. 2018;36(3):225-243 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29929595 https://www.sciencedirect.com/science/article/abs/pii/S0733863518300172
- ↑ Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022