Pruritis Vulvae Flashcards
What is pruritis vulvae?
Commonly caused by vulvovaginitis (e.g. vulvovaginal candidiasis, atrophic vaginitis, vulvar vestibulitis and contact dermatitis) à infection, eczema, contact dermatitis
o Candidiasis – nearly 75% of all women will experience candidiasis in their lifetime
o Atrophic vaginitis – 10-40% of post-menopausal women
What are the signs and symptoms of pruritis vulvae?
o Vulvovaginal candidiasis:
§ Vulvar pruritus, burning, erythema and oedema of the vestibule and labia, thick white curd-like PVD
§ Chronic – grey-sheen of epithelial cells, severe pruritus, irritation and pain, lichenification of vulva
o Atrophic vaginitis:
§ Soreness, dyspareunia, burning leucorrhoea (white mucous discharge), occasional spotting
o Vulvar vestibulitis:
§ Primary (20%) – introital dyspareunia
§ Secondary – introital dyspareunia that develops after period of comfortable sexual relations, etc.
§ Pain, soreness, burning, rawness
o Contact dermatitis:
§ Pruritus, can get burning, pain, red, ulcerative skin following contact
What investigations would you do for pruritis vulvae?
o Vulvovaginal candidiasis = wet-mount test or KOH preparation
o Atrophic vaginitis = vaginal pH and wet-mount test (often shows white blood cells and paucity of lactobacillus)
What is the management of pruritis vulvae?
o Vulvovaginal candidiasis:
§ Ketoconazole (400mg/day) or fluconazole (100mg/week) for 6 weeks
§ Clotrimazole 500mg suppositories once per week
o Atrophic vaginitis:
§ Topical vaginal oestrogen or HRT
o Vulvar vestibulitis:
§ Pain management with sex therapy, behaviour modification, topical steroid, anaesthetic, petroleum jelly, anti-inflammatories. Surgical excision as last resort – success rate of 60-80%
o Contact dermatitis:
§ Remove itching agent
§ Mild CD -> 1% hydrocortisone creams
§ Moderate CD -> betamethasone
§ Triamcinolone ointment applied BD
§ Wet compresses of aluminium acetate for severe lesions
§ If seborrhoeic dermatitis, consider ketoconazole shampoo body wash
What are the complications of pruritis vulvae?
o Atrophic vaginitis – super infection due to raised vaginal pH
o Candida – disruption to social and sexual life
o Prognosis:
§ Atrophic vaginitis – substantial relief with treatment
§ Candida – good with treatment but frequent recurring attacks in 5
