Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Dermatitis of the vulva

INTRODUCTION

Vulvar dermatitis (also called vulvar eczema) is the most common vulvar dermatosis in women. One-third to one-half of women's vulvar complaints stem from this problem [1-3]. It can develop in isolation or may occur as part of dermatitis in other areas of the body.

Women with vulvar dermatitis experience chronic irritation and/or pruritus, which causes them to persistently rub and scratch the vulva. These activities lead to histological changes in the dermis, termed squamous hyperplasia or lichen simplex chronicus.

ENDOGENOUS VERSUS EXOGENOUS DERMATITIS

The two types of vulvar dermatitis are endogenous and exogenous.

Endogenous vulvar dermatitis is the term used to describe atopic dermatitis of the vulva. Atopic dermatitis has a familial predisposition, often begins in childhood, and is characterized by pruritus. Although some experts feel that vulvar involvement is unusual, even when there is severe and widespread atopic dermatitis elsewhere (picture 1), others believe it is more prevalent than previously acknowledged [4,5]. In women with atopic dermatitis at nongenital periorificial sites, the occurrence of erythema in the labial folds, the perianal region, and in the skin between the buttocks probably represents endogenous vulvar dermatitis. (See "Epidemiology, clinical manifestations, and diagnosis of atopic dermatitis (eczema)".)

Exogenous vulvar dermatitis results from external factors, and is also called contact dermatitis (picture 2A-B). In allergic contact dermatitis (20 percent of cases), the trigger (allergen) induces an immune response, while in irritant contact dermatitis (80 percent of cases), the trigger (irritant) itself directly damages the skin. Although exposure to irritants may have been the initial cause of the dermatitis, secondary sensitization to allergens can also occur.

                    

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2014. | This topic last updated: Jul 3, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Ball SB, Wojnarowska F. Vulvar dermatoses: lichen sclerosus, lichen planus, and vulval dermatitis/lichen simplex chronicus. Semin Cutan Med Surg 1998; 17:182.
  2. Fischer G, Spurrett B, Fischer A. The chronically symptomatic vulva: aetiology and management. Br J Obstet Gynaecol 1995; 102:773.
  3. Fischer GO. The commonest causes of symptomatic vulvar disease: a dermatologist's perspective. Australas J Dermatol 1996; 37:12.
  4. Ridley CM, Neill SM. Non-infective cutaneous conditions of the vulva. In: The Vulva, Ridley CM, Neill SM (Eds), Blackwell Science, Oxford Ltd 1999.
  5. Pincus SH. Vulvar dermatoses and pruritus vulvae. Dermatol Clin 1992; 10:297.
  6. Marren P, Wojnarowska F, Powell S. Allergic contact dermatitis and vulvar dermatoses. Br J Dermatol 1992; 126:52.
  7. Nardelli A, Degreef H, Goossens A. Contact allergic reactions of the vulva: a 14-year review. Dermatitis 2004; 15:131.
  8. Farage M, Maibach HI. The vulvar epithelium differs from the skin: implications for cutaneous testing to address topical vulvar exposures. Contact Dermatitis 2004; 51:201.
  9. Elsner P, Wilhelm D, Maibach HI. Multiple parameter assessment of vulvar irritant contact dermatitis. Contact Dermatitis 1990; 23:20.
  10. Britz MB, Maibach HI. Human cutaneous vulvar reactivity to irritants. Contact Dermatitis 1979; 5:375.
  11. Marin MG, King R, Sfameni S, Dennerstein GJ. Adverse behavioral and sexual factors in chronic vulvar disease. Am J Obstet Gynecol 2000; 183:34.
  12. Bergeron C, Ferenczy A, Richart RM, Guralnick M. Micropapillomatosis labialis appears unrelated to human papillomavirus. Obstet Gynecol 1990; 76:281.
  13. Prieto MA, Gutiérrez JV, Sambucety PS. Vestibular papillae of the vulva. Int J Dermatol 2004; 43:143.
  14. Marren P, Wojnarowska F. Dermatitis of the vulva. Semin Dermatol 1996; 15:36.
  15. Lynch PJ. Dermatology, Williams & Wilkins, Baltimore 1994. p.4.
  16. Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther 2004; 17:8.
  17. www.asccp.org/edu/practice/vulva/squamous.shtml (Accessed on January 10, 2008).
  18. Bauer A, Rodiger C, Greif C, et al. Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva. Dermatology 2005; 210:143.
  19. Goldsmith PC, Rycroft RJ, White IR, et al. Contact sensitivity in women with anogenital dermatoses. Contact Dermatitis 1997; 36:174.
  20. Lewis FM, Harrington CI, Gawkrodger DJ. Contact sensitivity in pruritus vulvae: a common and manageable problem. Contact Dermatitis 1994; 31:264.
  21. Virgili A, Bacilieri S, Corazza M. Evaluation of contact sensitization in vulvar lichen simplex chronicus. A proposal for a battery of selected allergens. J Reprod Med 2003; 48:33.
  22. Margesson LJ. Contact dermatitis of the vulva. Dermatol Ther 2004; 17:20.
  23. Pelisse M. The vulvo-vaginal-gingival syndrome. A new form of erosive lichen planus. Int J Dermatol 1989; 28:381.
  24. Sobel JD, Faro S, Force RW, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998; 178:203.
  25. Herbst R. Perineal streptococcal dermatitis/disease: recognition and management. Am J Clin Dermatol 2003; 4:555.
  26. Jones SM, Sampson HA. The role of allergens in atopic dermatitis. Clin Rev Allergy 1993; 11:471.
  27. Bleehen SS, Chu AC, Hamann I, et al. Fluticasone propionate 0.05% cream in the treatment of atopic eczema: a multicentre study comparing once-daily treatment and once-daily vehicle cream application versus twice-daily treatment. Br J Dermatol 1995; 133:592.
  28. Green C, Colquitt JL, Kirby J, Davidson P. Topical corticosteroids for atopic eczema: clinical and cost effectiveness of once-daily vs. more frequent use. Br J Dermatol 2005; 152:130.
  29. Dalziel KL, Wojnarowska F. Long-term control of vulval lichen sclerosus after treatment with a potent topical steroid cream. J Reprod Med 1993; 38:25.
  30. Dalziel KL, Millard PR, Wojnarowska F. The treatment of vulval lichen sclerosus with a very potent topical steroid (clobetasol propionate 0.05%) cream. Br J Dermatol 1991; 124:461.
  31. Goldstein AT, Parneix-Spake A, McCormick CL, Burrows LJ. Pimecrolimus cream 1% for treatment of vulvar lichen simplex chronicus: an open-label, preliminary trial. Gynecol Obstet Invest 2007; 64:180.
  32. Black RJ. Vulval eczema associated with propolis sensitization from topical therapies treated successfully with pimecrolimus cream. Clin Exp Dermatol 2005; 30:91.
  33. www.fda.gov/cder/drug/infopage/protopic/default.htm (Accessed on January 10, 2008).
  34. Segal AO, Ellis AK, Kim HL. CSACI position statement: safety of topical calcineurin inhibitors in the management of atopic dermatitis in children and adults. Allergy Asthma Clin Immunol 2013; 9:24.
  35. Tennis P, Gelfand JM, Rothman KJ. Evaluation of cancer risk related to atopic dermatitis and use of topical calcineurin inhibitors. Br J Dermatol 2011; 165:465.
  36. Robins DN. Intramuscular triamcinolone: a safe, effective and underutilized dermatologic therapy. J Drugs Dermatol 2009; 8:580.