Pruritus_Vulvae_Flashcards
How common is vaginal itching among women?
It is estimated that 1 in 10 women will seek help for vaginal itching at some point.
What differentiates pruritus vulvae from pruritus ani?
Pruritus vulvae usually has an underlying cause, whereas pruritus ani may not.
What is the most common cause of pruritus vulvae?
The most common cause of pruritus vulvae is irritant contact dermatitis (e.g. latex condoms, lubricants).
What are some underlying causes of pruritus vulvae?
Underlying causes of pruritus vulvae include irritant contact dermatitis, atopic dermatitis, seborrhoeic dermatitis, lichen planus, lichen sclerosus, and psoriasis.
How should women with pruritus vulvae be advised to clean the vulval area?
Women with pruritus vulvae should be advised to take showers rather than baths.
What type of product should be used to clean the vulval area in pruritus vulvae?
Women with pruritus vulvae should clean the vulval area with an emollient such as Epaderm or Diprobase.
How often should the vulval area be cleaned in cases of pruritus vulvae?
The vulval area should be cleaned only once a day as repeated cleaning can aggravate the symptoms.
What type of treatment will most underlying conditions of pruritus vulvae respond to?
Most underlying conditions of pruritus vulvae will respond to topical steroids.
What treatment may be tried if seborrhoeic dermatitis is suspected?
A combined steroid-antifungal treatment may be tried if seborrhoeic dermatitis is suspected.
summarise pruirtus vulvae
Pruritus vulvae
Vaginal itching is common. It is estimated that 1 in 10 women will seek help at some point.
In contrast to pruritus ani, pruritus vulvae usually has an underlying cause:
irritant contact dermatitis (e.g. latex condoms, lubricants): most common cause
atopic dermatitis
seborrhoeic dermatitis
lichen planus
lichen sclerosus
psoriasis: seen in around a third of patients with psoriasis
Management
women who suffer from this should be advised to take showers rather than taking baths
they should also be advised to clean the vulval area with an emollient such as Epaderm or Diprobase
clean only once a day as repeated cleaning can aggravate the symptoms
most of the underlying conditions will respond to topical steroids
combined steroid-antifungal may be tried if seborrhoeic dermatitis is suspected
A 56-year-old woman presents to her GP complaining of vulval itching and dyspareunia. She is post-menopausal, having experienced menopause 4 years prior and currently takes combined hormone replacement therapy. The itching is severe enough to disturb her sleep. There is no history of vaginal bleeding or discharge. Examination reveals pale white patches on the vulva with surrounding erythema. Her past medical history includes Hashimoto’s thyroiditis, for which she takes levothyroxine.
What is the most likely diagnosis?
Atrophic vaginitis
Irritant contact dermatitis
Lichen planus
Lichen sclerosus
Vulval carcinoma
Lichen sclerosus
An underlying cause can be identified in most cases of pruritus vulvae
Important for meLess important
Lichen sclerosus is the correct diagnosis. This autoimmune inflammatory skin condition predominantly affects the genitalia in post-menopausal women. The inflammation leads to atrophy of the epidermis and the formation of white ‘plaques’. The genitalia, perineum, and anus are commonly involved areas. A hallmark symptom of lichen sclerosus is pruritus vulvae, which can be severe enough to disturb a patient’s sleep. Additionally, it may cause dyspareunia and dysuria. Lichen sclerosus is associated with other autoimmune conditions, especially those related to the thyroid, such as Hashimoto’s thyroiditis. An important differential diagnosis to consider is vaginal candidiasis; both conditions present with itching and white lesions on the vulva. The primary treatment for lichen sclerosus involves high-potency topical corticosteroids complemented by emollients to address dryness.
Atrophic vaginitis is not the correct diagnosis since this condition typically presents with vaginal dryness, itching and potential bleeding due to irritation. Atrophic vaginitis results from decreased oestrogen levels leading to thinning of the vaginal mucosa, which manifests as dryness and bleeding. This patient is on hormone replacement therapy and therefore is unlikely to be suffering from atrophic vaginitis. Furthermore, white patches on the vulva are not characteristic of atrophic vaginitis but rather suggest lichen sclerosus or vaginal candidiasis.
Irritant contact dermatitis is incorrect. While it ranks among the most common causes of vaginal itching, it does not lead to white patches on the vulva as described in this vignette. Irritant contact dermatitis would exhibit erythema localised to skin regions exposed to irritants like latex; however, white patches would be uncharacteristic findings for this condition. Instead, these white patches are indicative of lichen sclerosus – an inflammatory skin disorder characterised by epidermal atrophy resulting in pallor.
Lichen planus is incorrect; although recognised as a potential cause of vaginal itching, it typically induces a pruritic papular rash rather than white plaques observed in this patient’s presentation. The presence of white plaques suggests lichen sclerosus – an autoimmune condition that leads to epidermal thinning and subsequent pallor relative to adjacent skin tissues. Given that a papular rash does not feature in this clinical picture, lichen planus becomes an unlikely diagnosis.
Vulval carcinoma is incorrect as this malignancy generally presents with a singular ulcer or lesion on the labia majora. This woman has the more characteristic signs of lichen sclerosus with pale, white patches of skin. Both vulval cancer and lichen sclerosus can present with vulval itching due to irritation of the lesions. Furthermore, you may also get inguinal lymphadenopathy with vulval cancer but this is not present in this patient. Given the difference in appearance of the two conditions, lichen sclerosus fits the more characteristic white, atrophied, patches of skin mentioned in this woman. If there was any doubt about the diagnosis and vulval cancer needed to be excluded, then a biopsy would be required.
