Vulvar pruritus is the most common symptom seen in women's vulvar dermatology clinics. Vulvar pruritus can be classified as primary or secondary. Secondary pruritus is when itching is secondary to or accompanied by a specific skin condition affecting the vulva, such as chronic lichen simplex, contact dermatitis, lichen sclerosus, or vaginal candidiasis. Primary vulvar pruritus refers to itching of the vulva without any other specific skin manifestations.
Etiology and pathogenesis
The cause of most cases of vulvar pruritus is unclear. Some literature suggests that these patients may have an atopic constitution. These patients or their relatives have a history of allergic rhinitis, conjunctivitis, or asthma, as well as allergic skin diseases.
In addition, the special characteristics of the vulvar skin, such as its relatively closed, moist, slightly warm, and thin skin, may also be predisposing factors for pruritus, as these factors may increase the sensitivity of the vulvar skin to external stimuli.
Some cases of vulvar pruritus occur around menopause and may be related to endocrine disorders, sex hormone changes, autonomic nervous system dysfunction, and emotional changes. Vulvar pruritus can occur alone or as a localized manifestation of generalized pruritus. Generalized pruritus can be associated with systemic diseases such as diabetes, chronic renal insufficiency, visceral tumors, and AIDS. Additionally, dry climates and dry skin can also cause vulvar or generalized pruritus.
Clinical manifestations
Vulvar pruritus commonly occurs in middle-aged and elderly women and can affect the labia majora and minora, mons pubis, and even the entire perineum and perianal area. Itching is often more pronounced at night, varying in severity, and is usually intermittent. It can be triggered by factors such as alcohol consumption or hot baths. In the early stages, the skin only presents with itching, without a primary rash. If the condition is prolonged and involves repeated scratching, scratch marks, crusting, increased pigmentation, and lichenification may appear on the vulva.
Diagnosis and differential diagnosis
The key diagnostic criteria for vulvar pruritus are itching of the vulva without primary skin lesions. Before diagnosing this condition, it is essential to rule out other skin or gynecological diseases that cause vulvar pruritus, such as trichomoniasis, vaginal candidiasis, chronic lichen simplex, contact dermatitis, urticaria, and lichen sclerosus, especially contact dermatitis and urticaria.
treat
Try to identify the cause and triggering factors, especially potential contact allergens. Patch testing may be necessary. After eliminating the cause and triggering factors, the main treatment is to relieve itching. For milder cases, topical moisturizers can be used alone. For more severe itching, oral antihistamines and topical corticosteroids may be considered. However, caution should be exercised regarding long-term topical corticosteroid use and potential adverse reactions in the vulva. In recent years, calcineurin inhibitors such as tacrolimus and pimecrolimus have been used topically to treat vulvar pruritus. However, these drugs can irritate the skin of some patients and may even worsen itching; patients with vulvar pruritus should be aware of this when using them.
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