Vulval eczema

Question 1

Definition of vulval eczema

Answer 1

. Atopic: the ‘allergic’ type often seen in people who
also have hay fever or asthma.
. Allergic contact: due to skin contact to a substance
to which the individual is sensitive.
. Irritant contact: due to skin contact with irritating
chemicals, powders, cleaning agents

Question 2

Diagnosis of vulval eczema

Answer 2

. Clinical presentation.
. General examination of the skin to look for other
signs of dermatitis

Question 3

Investigations for vulval eczema

Answer 3

• Patch testing – standard battery and medicaments.
  . Biopsy – only if atypical features (e.g. asymmetric,
  localised or eroded) or failure to respond to
  treatment.

Question 4

Treatment of vulval eczema

Answer 4

. Avoidance of precipitating factor.
. Use of emollient soap substitute (aqueous cream should
not be applied as a moisturiser due to the risk of irritant
effects; Hydramol can be a suitable alternative).
. Topical corticosteroid – the choice of preparation
will depend on severity, 1% Hydrocortisone
ointment in milder cases, or betamethasone valerate
0.025% or clobetasol propionate 0.05% for limited periods if severe or lichenified. A combined
preparation containing antifungal and/or antibiotic
may be required for short-term use (to try and avoid the development of contact allergy) if secondary
infection suspected. Apply once daily