PRURITUS VULVA

A lichenified plaque in the pubic area of this woman who rubbed nightly.
Lichen simplex chronic of the vulva


Clinical

Chronic pruritus of the vulva can be a very troublesome problem. Ask about any scrubbing of the labia. If they do, don't! Lichen simplex chronicus may have developed without other pathology. Are they incontinent? Fecal? Do they apply any of a variety of things, e.g. Witchy hazel, tea tree oil, 20% benzocaine to the area. If they do, stop! Physical examination should attempt to rule out candidiasis, tinea, erythrasma, trichomonal vaginitis, allergic contact dermatitis, irritant dermatitis, extramammary Paget's disease and LSA.

Young girls may develop vulvar pruritus just from poor hygiene. Children may rush bathroom visits and not wipe properly. An irritant dermatitis with inflammation and itching results. Treatment includes education, loose-fitting cotton underwear, and daily baths to make sure the genitalia are properly cleansed.

Treatment

Any cause of pruritus should be treated. No rubbing or scratching please. Be very gentle with the area. Stop all products. Use simple cleansing with no fragrance. A medium potency topical steroid, e.g. triamcinolone ointment may be prescribed. If the skin is severely lichenified as in lichen simplex chronicus, or the itch is very intense, several weeks of clobetasol ointment nightly may be needed.

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