Pruritus Vulvae

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Pruritus Vulvae
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Specialty scores for Pruritus Vulvae

Overview

Pruritus vulvae is the sensation of itch in the genital area of the females. Itching is felt in vulva (external genitalia of female), that includes the mons pubis, labia majora (outer lips), labia minora (inner lips), clitoris, area between vagina and anus and the external openings of the urethra and vagina.

Causes:

Very commonly pruritus vulvae may be due to many types of infections, of which Candida albicans infection (vulvovaginal thrush) is the most important. Postmenopausal women do not usually have Candida albicans infection, unless they are diabetic, suffer with immune deficiency or are treated with estrogen hormone or antibiotics.

Several less common infections that may cause vulval itch include bacterial vaginosis (frothy, malodorous discharge), genital viral warts, pinworms in the vagina or anus, cytolytic vaginosis (associated with vaginal lactobacilli) and trichomoniasis.

Pruritus vulvae may be due to an inflammatory skin condition and irritant contact dermatitis is the most common cause at all ages. It can be due to diverse causes, including age-related prepubertal or postmenopausal lack of oestrogen, tendency to develop atopic dermatitis, persistent scratching of external genitalia, friction from skin folds, clothing, or sexual intercourse, exposure to persistent moisture due to occlusive underwear, exposure with soap or harsh cleanser, frequent washing of vulva, inappropriate chemical applications, fissuring of the posterior fourchette, and excessive or infected vaginal secretions.

Common dermatological conditions that may cause pruritus vulvae include Lichen simplex, Lichen sclerosus, Lichen planus, Psoriasis, Seborrhoeic dermatitis, Allergic contact dermatitis, Irritant or allergic contact urticaria, Dermographism & Folliculitis.

Potential vulval allergens include Methylisothiazolinone (preservative in moist wipes), Various cloth dyes used in underwear, Fragrance in a douche, Rubber accelerants in condom or underwear, and latex rubber. Pruritus vulvae may be due to underlying benign and malignant disorders, such as Squamous intraepithelial lesions, Extramammary Paget disease & Invasive vulval cancer.

Signs and symptoms:

Clinical signs and symptoms of pruritus vulvae include severe itching in vulva, scratch marks or excoriations on the vulva and the specific clinical features associated with the underlying cause of the itch. Depending over the underlying cause of the pruritus vulvae, there may be presence of vaginal discharge, swelling of vulva, redness of vulva, and presence of superficial papules, pustules, desquamation and erosions. Complications of pruritus vulvae include psychological distress, irritability, secondary bacterial infections over the scratched region and sleeplessness.

Diagnosis:

The condition is diagnosed through careful history and examination of the vulva. Bacterial and viral swabs of the affected skin and of the vagina should be subjected to microbiological examination. Skin biopsy of the affected skin is necessary to determine the underlying pathology. Patch tests are performed to evaluate any contact allergy.

Treatment:

Treatment of pruritus vulvae includes oral and topical antifungal agents, antibiotics, antiviral medications, topical steroids, calcineurin inhibitors, oral antihistamines and emollients. If underlying neoplastic condition is responsible for pruritus vulvae, surgery or appropriate therapy is indicated. To manage symptoms of depression and psychological stress, triyclic antidepressants may be used. Non-specific treatment includes minimising scratching or rubbing the affected region, wearing loosely fitting undergarments, avoiding occlusive nylons, keeping cool and using barrier preparations.