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vulvar pruritus

Intense itching of the female external genitalia Etiology: 1) vulvovaginitis 2) essential pruritus (localized neurodermatitis) 3) lichen simplex chronicus 4) lichen planus 5) vulvar vestibulitis 6) urinary tract infection 7) atrophic vaginitis secondary to estrogen deprivation 8) human papilloma virus (condylomata acuminata) 9) vulvar carcinoma 10) lichen sclerosus et atrophicus (LSA) 11) seborrheic dermatitis 12) fecal irritation secondary to fecal incontinence 13) contact dermatitis 14) parasitic infection a) crab lice b) pinworms c) scabies d) insect bites 15) neurogenic/psychiatric 16) Fox-Fordyce disease (apocrine sweat gland occlusion) 17) systemic disorders a) diabetes b) drug hypersensitivity c) gout d) pellagra e) pregnancy f) Sjogren's syndrome g) psoriasis h) lymphoma i) leukemia j) hepatic disease k) renal disease l) carcinomatosis m) polycythemia Clinical manifestations: 1) pruritus 2) visible skin changes 3) warts, tumors, ulcers & scaling 4) vaginal or anal discharge 5) colposcopic & histologic changes Laboratory: 1) wet mount & KOH preparation of vaginal secretions 2) biopsy of all suspicious lesions 3) urinalysis & urine culture 4) complete blood count 5) scotch tape test 6) chemistry panel a) glucose b) urea nitrogen c) liver function tests Special laboratory: 1) colposcopy if indicated 2) patch testing if indicated for allergies/contact dermatitis Management: 1) acute vulvar pruritus - hydroxyzine (Atarax, Vistaril) 25-50 mg PO TID-QID & QHS - doxepin (Sinequan, Adaptin) 25-50 mg pi BID-TID - terfenadine (Seldane) 60 mg PO TID - amitriptyline (Elavil) 25 mg PO QHS - topical lidocaine (Xylocaine) - cromatin cream (initial burning will occur) - prednisone taper - ice packs at night 2) chronic vulvar pruritus a) 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 b) subcutaneous triamcinolone acetonide 3) Diet: avoid caffeine, peanuts, tomatoes 4) 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 5) CAUTION: pruritus is the most common presentation of vulvar carcinoma & vaginal cancer

Related

vulva vulvar dystrophy (vulvar disorder) vulvodynia; vulvar pain; vulvar burning; vulvar itching

General

gynecologic disease pruritus (itching)

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 398-99
  2. 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: 20883911
  3. Chibnall R. Vulvar pruritus and lichen simplex chronicus. Obstet Gynecol Clin North Am. 2017;44(3):379-388 PMID: 28778638 https://www.sciencedirect.com/science/article/abs/pii/S0889854517300700
  4. Savas JA, Pichardo RO. Female genital itch. Dermatol Clin. 2018;36(3):225-243 PMID: 29929595 https://www.sciencedirect.com/science/article/abs/pii/S0733863518300172
  5. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022