Vulvar itchBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l83 (Published 07 February 2019) Cite this as: BMJ 2019;364:l83
- A Alani, ST6 dermatology trainee, former general practitioner1,
- L McDonald, ST5 dermatology trainee, former general practitioner,1,
- W Abdelrahman, consultant dermatologist2,
- H L Hunter, consultant dermatologist2
- 1Dermatology unit, Royal Victoria Hospital, Belfast, UK
- 2Belfast City Hospital, Belfast Health and Care Trust, Belfast, UK
- Correspondence to A Alani
What you need to know
Suspect inflammatory skin diseases in women with itching in the genital area
A history of using feminine hygiene products, latex condoms, lubricants, or fragrances may suggest irritant contact dermatitis
Look for concomitant skin lesions elsewhere on the body which may provide clues to a diagnosis of seborrhoeic dermatitis, psoriasis, or lichen planus
Erosion of vulval architecture is seen in lichen planus and severe lichen sclerosus
Urgently refer patients with suspicious lesions such as ulceration, lump, or swelling in the vulva, or lesions in the vagina or cervix for biopsy to rule out malignancy
One in 10 women seek help for genital itching at some point in their lifetime.1 Skin conditions affecting the vulva or genital area are usually responsible.
A small survey of general practitioners in England, found that most (67% of 107 participants) saw more than five patients each month with vulvar symptoms, predominantly itching.2 But the true prevalence of symptoms is likely to be underestimated as patients may be embarrassed, and or use over the counter creams and products for symptomatic relief.
This Practice Pointer aims to help non-specialists recognise and treat common dermatological causes of vulvar itch.
What are common dermatological causes of vulvar itch?
Table 1 describes the key clinical features of dermatological vulvar itch.
Irritant contact dermatitis can occur after skin contact with irritating chemicals—for example, detergents, fragrances, and lubricants (box 1). It is a particular problem in women with urinary incontinence.34
Common skin irritants345
Lubricants—spermicides, preservatives, anaesthetics
Toiletries—preservatives or stabilisers—eg, quaternium-15, propylene glycol
Topical treatments—corticosteroids, antimicrobials, anaesthetics, preservatives, or stabilisers
The genital area is often unaffected in patients with atopic dermatitis. However, repeated rubbing and scratching can result in lichen simplex chronicus, characterised by darkened and thickened skin. Lichenification usually affects the …