PRURITUS VULVAE
Definition:
Pruritus means sense of itching.
When it is confined to the vulva, it is called pruritus
vulvae. It should not be confused with pain.
Mechanisms of Itching:
The possible
mechanisms of the repetitive ‘itch-scratch’ cycle are
mediated through the following:
™ Special sensory innervation of the area.
™ Underlying vascular instability (greatly influenced
by emotion) results in production of histamine-like
substance → induction of itching.
™ Aggravation at night because of:
− Absence of distraction of mind.
− Tired central nervous system.
− Local warmth and lack of aeration.
Etiology:
Vaginal discharge—The most common
cause of pruritus vulvae is vaginal discharges either
due to Trichomonas vaginalis or Candida albicans or
both.
Local skin lesions—The lesions may be either
localized in the vulva or part of generalized lesions.
Such lesions include — psoriasis, seborrheic derma-
titis, intertrigo, etc.
Infections of the vulva
Fungal—Candida.
Viral—Herpes genitalis, genital warts.
Parasitic—Threadworm may migrate to the area
(especially in children), scabies, pediculosis.
STD—Gonorrhea, Trichomoniasis.
Allergy or contact dermatitis—Use of nylon
undergarments or washing those with certain soaps
or detergents, idiosyncrasy to chemical contrace-
ptives or condom is often related.
Non-neoplastic epithelial disorders of the vulva
Squamous hyperplasia
Lichen sclerosus
Neoplastic epithelial disorders
vin.
Paget’s disease
Invasive carcinoma of the vulva
Pruritus vulvae due to some systemic diseases
A. Medical disorders: Glycosuria (diabetes
mellitus) causes local changes in the skin (raw
beef color) and pruritus. It favors the growth of
Candida. Others:Thyroid disorders, Chronic liver
disease.
B. Dermatological causes:Contact dermatitis, drug
allergy.
C. Deficiency state:Deficiencies of iron, folic acid,
vitamin B12 and vitamin A are all implicated.
D. Psychosomatic causes: When no cause is de-
tected, psychic factor is to be excluded. Mental
anxiety or sexual frustration may be responsible
for scratching.
Investigations :
• Microscopic examination of the vaginal discharge
or vulval scraping to detect Candida or Tricho-
monas vaginalis.
• Urine for sugar, protein and pus cells.
• Blood—Complete blood count, postprandial
glucose. Detailed hematological workup (polycy-
themia, leucemia), thyroid profile, liver function
and renal function tests are carried out.
• Stool—Ova, parasites and cysts are to be looked
for.
• In long-standing cases (more than one year)
especially with vulval epithelial disorders, biopsy
either random or colposcopic directed, is to
be taken to note the type of skin changes and
exclude malignancy.
Examination
General examination—Thorough systemic exami-
nation is needed. Examination for diabetes mellitus,
liver and thyroid disorders, hematological diseases
are to be made.
Local examination—The extent of the lesion is to
be noted.
Treatment:
General principles
™ Appropriate local hygiene is to be taken care of.
™ To use loose fitting undergarments preferably
made of cotton to keep the area aerated.
™ To prevent the vicious cycle of ‘itch-scratch’.
Local application of antibiotics or clobetasol
propionate 0.05 percent ointment may be
helpful. If the skin is atrophic, estrogen or testosterone
cream may be helpful.
™ To treat the specific etiological factor causing
pruritus by appropriate therapy—local or systemic.
Surgery:
Surgery may be needed when biopsy
confirms features of neoplasia (VIN or invasion).
~ Thank you for reading ......
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