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Review
. 2020 Feb 21;116(8):126-133.
doi: 10.3238/arztebl.2020.0126.

Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach

Linn Woelber  1 , Katharina Prieske, Werner Mendling, Barbara Schmalfeldt, Hans-Jürgen Tietz, Anna Jaeger
Affiliations
Review

Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach

Linn Woelber et al. Dtsch Arztebl Int. .

Abstract

Background: In Germany, 17-23% of the population suffers from chronic itching of the skin; in 5-10% of cases, the female genitalia are affected, specifically, the vulva. Vulvar pruritus is thus a common symptom that often markedly impairs the affected women's quality of life.

Methods: This review is based on pertinent publications that were retrieved by a selective search in MEDLINE/PubMed for articles on the pathogenesis, diagnosis, and treatment of vul- var pruritus. The search terms were (in German and English) "vulvärer Juckreiz," "pruritus vulvae," and "genital itch," alone and in combination with "Behandlung," "Therapie," or "treat- ment."

Results: The most common cause of vulvar pruritus is vulvo- vaginal candidiasis followed by chronic dermatoses, such as lichen sclerosus and vulvar eczema. Especially in refractory cases, an invasive or preinvasive lesion such as squamous epithelial dysplasia (VIN, vulvar intraepithelial neoplasia) should be borne in mind in the differential diagnosis. Rarer causes include infection, atrophy, and vulvodynia. The essen- tial elements of treatment are topical/oral antimycotic drugs and high-potency glucocorticoids, along with consistently ap- plied, basic moisturizing care and the avoidance of potential triggering factors.

Conclusion: As vulvar pruritus has multiple causes, standard- ization of its diagnostic evaluation and treatment would be l efficacy and to meet the diverse needs of women who suffer from this condition.

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Figures

Figure 1
Figure 1
Differential diagnostic work-up and diagnosis of vulvar pruritus by morphology (nomenclature see Box); bact., bacterial; surg., surgical; ultrapot., ultrapotent; GC, glucocorticoids; Inf., infection; mechan., mechanical; NAAT, nucleic acid amplification test; p.o., per os; VIN, vulvar intraepithelial neoplasia
Figure 2
Figure 2
Common differential diagnoses of vulvar pruritus
eFigure
eFigure
Differential diagnostic work-up and diagnosis of vulvar pruritus by symptom (according to Stockdale Obstet Gynecol 2018 [e46]); VIN, vulvar intraepithelial neoplasia
See this image and copyright information in PMC

Comment in

  • Some Additional Aspects.
    Haufs MG. Haufs MG. Dtsch Arztebl Int. 2020 Sep 11;117(37):612. doi: 10.3238/arztebl.2020.0612a. Dtsch Arztebl Int. 2020. PMID: 33263533 Free PMC article. No abstract available.
  • Inquire About Use of Panty Liners.
    Forck S. Forck S. Dtsch Arztebl Int. 2020 Sep 11;117(37):612. doi: 10.3238/arztebl.2020.0612b. Dtsch Arztebl Int. 2020. PMID: 33263534 Free PMC article. No abstract available.
  • Interventional Surgical Treatment Options.
    Mirastschijski U, Schwenke C. Mirastschijski U, et al. Dtsch Arztebl Int. 2020 Sep 11;117(37):612. doi: 10.3238/arztebl.2020.0612c. Dtsch Arztebl Int. 2020. PMID: 33263535 Free PMC article. No abstract available.

References

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    1. Yosipovitch G, Bernhard JD. Chronic pruritus. N Engl J Med. 2013;368:1625–1634. - PubMed
    1. Petersen EE. Chronischer Juckreiz im Genital. Ars Medici. 2011;13+14:559–562.
    1. Bohl T. Overview of vulvar pruritus through the life cycle. Clin Obstet Gynecol. 2005;48:786–807. - PubMed
    1. Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol. 2001;185:545–550. - PubMed

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