Pruritus Vulvae

Description

• Pruritus vulvae is a symptom or can be a primary diagnosis.
• If a primary diagnosis, other etiologies must be excluded
• Pruritus vulvae as a primary diagnosis may also be more appropriately documented as vulvodynia (see “Vulvodynia” topic) or burning vulva syndrome.

Epidemiology

Symptoms may occur at any age during a woman’s lifetime.

• Young girls most commonly have infectious or hygiene etiology.
• The primary diagnosis is more common in postmenopausal women.

Incidence
The exact incidence is unknown, although most women complain of vulvar pruritus at some point in their lifetime.

Etiology and Pathophysiology

Vulvar tissue is more permeable than exposed skin due to differences in structure, occlusion, hydration, and susceptibility to friction. It is particularly vulnerable to irritants such as (1)

• Perfumes
• Soaps
• Vaginal hygiene products
• Topical medications
• Dyes
• Body fluids

Risk Factors

• High-risk sexual behavior
• Immunosuppression
• Obesity

General Prevention

• Avoid irritants.
• Tight-fitting clothing should be avoided.
• Only cotton underwear should be worn.

Commonly Associated Conditions

• Infectious etiology
  • Vaginal or vulvar candida
  • Gardnerella vaginalis
  • Trichomonas
  • Human papillomavirus
  • Herpes simplex virus
• Vulvar vestibulitis
• Lichen sclerosus
• Lichen planus
• Lichen simplex chronicus (squamous cell hyperplasia)
• Malignant or premalignant conditions
• Psoriasis
• Fecal or urinary incontinence
• Dermatophytosis
• Parasites: scabies, Pthirus pubis
• Extramammary Paget
• Dietary: methylxanthines (e.g., coffee, cola), tomatoes, peanuts
• Autoimmune progesterone dermatitis: perimenstrual eruptions
• Irritant or allergic contact dermatitis
• Atopic dermatitis