Pruritus vulvae Flashcards
Which dermatological conditions cause pruritus vulvae?
- Contact dermatitis
- Psoriasis
- Seborrhoeic dermatitis
- Lichen simplex
- Lichen planus
- Lichen sclerosus
- Symptomatic dermatographism - localised urticaria triggered by direct firm touch, scratching or rubbing
What infections and infestations can cause pruritus vulvae?
- Candidiasis
- Trichomoniasis
- Bacterial vaginosis
- Genital herpes simplex
- Pubic lice (pediculus pubis)
- Scabies (sarcoptes scabiei)
Which malignant and premalignant conditions may cause pruritus vulvae?
Malignant neoplasms of the vulva - SCC account for 90% of which 60% are due to HPV; often 65-75 year olds; vulval lichen sclerosus or planus predispose to vulval neoplasms.
Pre-malignant - vulval intraepithelial neoplasia (VIN) - may be symptom-free but most are itchy or burning sensation; usually 1 or more slightly raised, red/white/pink/brown well defined lesions that can develop into invasive cancer but only after ~10 years
What are the two types of VIN?
- High grade squamous intraepithelial lesion (usual-type) — risk factors include smoking and immunosuppression.
- Intraepithelial neoplasia (differentiated-type) — associated with lichen sclerosus.
What hormonal changes can cause pruritus vulvae?
- Atrophic vulvovaginitis - due to declining oestrogen peri-menopause or in pregnant women where high prolactin may be antagonistic on oestrogen production
- Pregnancy - due to increased physiological vaginal discharge and risk of candidal vulvovaginitis
What GI conditions can cause pruritus vulvae?
- GI disease - prolonged contact of stool with vulval skin due to faecal incontinence or poor perianal hygiene e.g. IBS, Crohn’s., UC, anal fissures.
- Urinary and faecal incontinence - inflammation may present as pruritus
What systemic conditions can cause pruritus vulvae?
- Any generalised cause of pruritus e.g. drugs (NSAIDs, tetracyclines like dyxycycline), systemic disease like renal/hepatic, diabetes, thyroid, Fe def anaemia.
- Stress
- Psychological problems
What can cause contact dermatitis leading to PV?
- Proprietary creams
- Topical antibiotics e.g. neomycin
- Barrier contraceptives or lubricants
- Perfumes, soaps, bubble baths, wet wipes
- Detergents, fabric conditioners, bleaches, dyes
What can vulval psoriasis look like? How common is it to have genital involvement in psoriasis?
Classic psoriatic lesion* is replaced with a poorly demarcated, erythematous plaque with minimal scale and shiny texture due to moisture and friction of the skin folds
>30% of people have genital involvement in psoriasis
*Well-demarcated border, with erythematous plaques and silvery scale
What does lichen simplex of the vulva look like? Who is affected?
- Often seen in those with atopic skin disease
- Localised plaque of chronic eczematous inflammation created by rubbing or scratching of the skin
- May look leathery or lichenified
What does lichen planus of the vulva look like? What is a risk of this?
Appear as:
- erosive, glazed or glossy erythematous plaques;
- bluish-purple, shiny, flat-topped papules
- with small white dots or lines (Wickham’s striae);
- or uniformly white hyperkeratotic plaques.
Small risk of SCC development
What does lichen sclerosus of the vulva look like? What is a risk associated with it?
NB: affects anogenital area more than other cutaneous surfaces
- Any area from clitoral hood to perianal region affected but not the vagina
- Hypopigmented-to-white, crinkled, fragile plaques classically distributed in a figure eight pattern around the vulva, perineal body, and perianal skin.
Risks: scarring may cause loss of valvular architecture, resoprtion of labia minora but not loss of clitoris. <5% risk of SCC.
What are some rare dermatological causes of pruritus vulvae?
All very rare:
Fox-Fordyce disease - small dome-shaped flesh coloured to red papules affect all hair follicles in the area
Hailey-Hailey disease - blistering disease affecting skin fold and causing malodourous plaques
Darier disease - persistent greasy, scaly papules which are firm and may feel like sandpaper.
What is shown?
Fox-Fordyce disease
What is shown?
Hailey-Hailey disease
What is shown?
Darier disease
