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Pruritus vulvae - Management
Which dermatological conditions can cause pruritus vulvae?

  • Contact dermatitis (most common cause of pruritus vulvae) — reaction to proprietary creams (especially those containing local anaesthetics); topical antibiotic preparations (neomycin); barrier contraceptives; perfumes; soaps; bubble baths, wet wipes; textile dyes; detergents; fabric conditioners (can cause contact allergy or aggravate vulval symptoms); and bleaches, dyes, and perfumes in sanitary wear, such as panty liners, tampons, and sanitary towels.
  • Psoriasis — well-demarcated border, absence of scale when affecting the vulval area, often with typical psoriasis lesions elsewhere on the body.
    • For more information, see the CKS topic on Psoriasis.
  • Seborrhoeic dermatitis — ill-defined border, some scaling, with or without involvement of other sites, such as the axillae, face (eyebrows or nasolabial folds), anterior chest, or scalp.
  • Lichen simplex — thickened plaques with exaggerated skin markings over the hair-bearing labia majora and sparing the mucosal vulval skin and labia minora (the end result of an itch-scratch-cycle, regardless of the initial underlying cause of the itch).
  • Lichen planus — erythema and or erosive pattern, ulceration with intense pruritus, destruction of vulval architecture (possibly with other sites involved such as the nails and buccal mucosa). Lesions are bluish-purple, shiny, flat-topped papules with small white dots or lines (Wickham's striae). There is a small risk of squamous cell carcinoma developing in women with lichen planus (less than 3%).
  • Lichen sclerosus — lesions are white papules and or plaques, often associated with areas of bruising and usually found on the interlabial sulci, labia minora, clitoral hood, clitoris, perineal body, and perineum. Affected skin appears somewhat crinkly, like cigarette paper. Bleeding into the affected areas produces red or purple purpuric lesions. Scarring and loss of tissue can lead to burying of the clitoris, loss of the labia minora, and narrowing of the vulval introitus. There is a small risk of squamous cell carcinoma developing in women with lichen sclerosus (less than 5%).
  • Fox–Fordyce disease (very rare) — small dome-shaped papules, with or without involvement of the axillae; intensely itchy and often presenting as lichenification (grossly thickened skin with accentuated skin markings).
  • Hailey–Hailey disease (very rare) — vesicles erupt causing pruritus, with or without involvement of the axillae and sides of the neck. It is also known as 'familial benign chronic pemphigus', and is an inherited autosomal dominant condition. It is easily mistaken for intertrigo or dermatitis.
  • Darier's disease (very rare) — warty plaques, which may be macerated and malodorous, possibly with the involvement of seborrhoeic areas of the trunk, flank, and face. An autosomal dominant condition, which may be confused with Hailey–Hailey disease.
  • Symptomatic dermatographism — a form of localized urticaria triggered by a direct firm touch, scratching, or rubbing.
  • Images of the different conditions listed above that can cause pruritus vulvae can be found at www.dermnet.com.

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