Pruritus Vulvae Disease

DESCRIPTION

Pruritus vulvae is both a symptom and a pathologic process affecting the vulva. It is a symptom of underlying disease in the vast majority of the patients. As a primary diagnosis, it consists of irritation and vulvar itching without an underlying pathologic etiology.

System(s) affected: Skin/Exocrine
Genetics: Unknown
Incidence/Prevalence in USA: The exact incidence is unknown, although most women will complain of vulvar pruritus at some time during their life
Predominant age:
- Any age can be affected
- In young girls, it is usually caused by an infection
- Frequent in postmenopausal women
Predominant sex: Female only

SIGNS AND SYMPTOMS

Constant itching of the vulva
Constant burning of the vulva

CAUSES

Infectious causes - vaginal yeast infections, Gardnerella, other vaginal infections, and yeast dermatitis of the vulva itself
Urinary tract infections will produce vulvar burning on occasion
Vulvar vestibulitis (inflammation of the vestibular glands) produces a constant burning with pruritus and dyspareunia
Human papillomavirus (HPV) has been associated with burning and itching of the vulva
Vulvar tissues are estrogen sensitive. Estrogen deprivation can produce burning and itching.
A search for underlying malignancy should be paramount. Carcinoma in situ (Bowen's disease) and invasive malignancy will often be associated with pruritus.
Changes in the epidermis, such as lichen sclerosis et atrophicus (LSA) (thinning of the vulvar tissues and homogenization at the basement membrane) or hyperkeratosis of the vulva produce pruritus
Anal incontinence with fecal soilage produces pruritus
Excessive heat produces symptoms from sweat and irritation
Environmental and dietary irritants such as nylon, soaps, perfumes, and over-zealous cleansing can produce symptoms
Dietary irritants include methylxanthines (coffee, cola), tomatoes, peanuts

RISK FACTORS

N/A

LABORATORY

Vaginal secretions can be evaluated by wet mount (NaCl for trichomonas or Gardnerella, and KOH for yeast). Cultures seldom required.
Gram stain of the vagina is non-diagnostic as multiple organisms are present in the normal flora

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

These are related to the underlying etiology. In primary vulvar pruritus, no changes will be noted. If HPV is present, these changes will be seen in the cornified layer of the squamous epithelium.

SPECIAL TESTS

Whenever necessary, biopsy of the vulva should be used to establish the primary diagnosis

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Biopsy when needed

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Treatment of any underlying cause must be undertaken
In cases of idiopathic primary vulvar pruritus, conservative measures include sitz baths, topical steroid creams, avoidance of chemical irritants and dietary changes
When conservative measures fail, advanced cases can be treated with alcohol block or laser

SURGICAL MEASURES

Bowen's disease and premalignant changes are treated with excision or laser vaporization

ACTIVITY

Unlimited

DIET

A trial of dietary alteration should be attempted for idiopathic pruritus. Coffee and caffeine-containing beverages should be avoided. Other foods to avoid include tomatoes, peanuts.

PATIENT EDUCATION

See Prevention/Avoidance

PREVENTION/AVOIDANCE

Irritants to the vulva such as perfumes, soaps (use non-allergenic) or perfume douches must be avoided
Only cotton underwear should be worn
No tight fitting clothes or nylon pantyhose

POSSIBLE COMPLICATIONS

Chronic course

EXPECTED COURSE AND PROGNOSIS

Vulvar pruritus can be kept under control with conservative measures and topical steroids
When it advances to uncontrollable symptoms, alcohol block or laser may be necessary

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: More frequent
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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