- Natasha R Johnson, MD
Natasha R Johnson, MD
- Assistant Professor in Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Pamela L Scheinman, MD
Pamela L Scheinman, MD
- Associate Professor of Dermatology
- Harvard Medical School
- Alice J Watson, MD, MPH
Alice J Watson, MD, MPH
- Attending Dermatologist
- Brigham and Women’s Hospital
- Instructor in Dermatology
- Harvard Medical School
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
Vulvar dermatitis is the most common type of vulvar dermatosis. One-third to one-half of vulvar complaints stem from this problem [1-4]. It can develop in isolation or may occur as part of dermatitis in other areas of the body. Women with vulvar dermatitis often experience chronic irritation or pruritus, which cause them to persistently rub and scratch the vulva. These activities lead to histologic changes in the dermis, termed lichen simplex chronicus .
This topic will discuss the clinical manifestations, diagnosis, and management of vulvar dermatitis. Other vulvar dermatoses and vulvar lesions are discussed separately.
●(See "Vulvar lichen sclerosus".)
●(See "Vulvar lichen planus".)
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- Fischer G, Spurrett B, Fischer A. The chronically symptomatic vulva: aetiology and management. Br J Obstet Gynaecol 1995; 102:773.
- Fischer GO. The commonest causes of symptomatic vulvar disease: a dermatologist's perspective. Australas J Dermatol 1996; 37:12.
- Guerrero A, Venkatesan A. Inflammatory Vulvar Dermatoses. Clin Obstet Gynecol 2015; 58:464.
- Hoang MP, Reutter J, Papalas JA, et al. Vulvar inflammatory dermatoses: an update and review. Am J Dermatopathol 2014; 36:689.
- Ridley CM, Neill SM. Non-infective cutaneous conditions of the vulva. In: The Vulva, Ridley CM, Neill SM (Eds), Blackwell Science, Oxford Ltd 1999.
- Pincus SH. Vulvar dermatoses and pruritus vulvae. Dermatol Clin 1992; 10:297.
- Marren P, Wojnarowska F, Powell S. Allergic contact dermatitis and vulvar dermatoses. Br J Dermatol 1992; 126:52.
- Nardelli A, Degreef H, Goossens A. Contact allergic reactions of the vulva: a 14-year review. Dermatitis 2004; 15:131.
- 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.
- Elsner P, Wilhelm D, Maibach HI. Multiple parameter assessment of vulvar irritant contact dermatitis. Contact Dermatitis 1990; 23:20.
- Britz MB, Maibach HI. Human cutaneous vulvar reactivity to irritants. Contact Dermatitis 1979; 5:375.
- Bergeron C, Ferenczy A, Richart RM, Guralnick M. Micropapillomatosis labialis appears unrelated to human papillomavirus. Obstet Gynecol 1990; 76:281.
- Prieto MA, Gutiérrez JV, Sambucety PS. Vestibular papillae of the vulva. Int J Dermatol 2004; 43:143.
- Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther 2004; 17:8.
- Marren P, Wojnarowska F. Dermatitis of the vulva. Semin Dermatol 1996; 15:36.
- Marin MG, King R, Sfameni S, Dennerstein GJ. Adverse behavioral and sexual factors in chronic vulvar disease. Am J Obstet Gynecol 2000; 183:34.
- Bauer A, Rodiger C, Greif C, et al. Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva. Dermatology 2005; 210:143.
- Goldsmith PC, Rycroft RJ, White IR, et al. Contact sensitivity in women with anogenital dermatoses. Contact Dermatitis 1997; 36:174.
- Lewis FM, Harrington CI, Gawkrodger DJ. Contact sensitivity in pruritus vulvae: a common and manageable problem. Contact Dermatitis 1994; 31:264.
- 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.
- Margesson LJ. Contact dermatitis of the vulva. Dermatol Ther 2004; 17:20.
- O'Gorman SM, Torgerson RR. Allergic contact dermatitis of the vulva. Dermatitis 2013; 24:64.
- Al-Niaimi F, Felton S, Williams J. Patch testing for vulval symptoms: our experience with 282 patients. Clin Exp Dermatol 2014; 39:439.
- Vermaat H, Smienk F, Rustemeyer T, et al. Anogenital allergic contact dermatitis, the role of spices and flavour allergy. Contact Dermatitis 2008; 59:233.
- Silvestri DL, Barmettler S. Pruritus ani as a manifestation of systemic contact dermatitis: resolution with dietary nickel restriction. Dermatitis 2011; 22:50.
- www.asccp.org/edu/practice/vulva/squamous.shtml (Accessed on January 10, 2008).
- Kirtschig G, Becker K, Günthert A, et al. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol 2015; 29:e1.
- Pelisse M. The vulvo-vaginal-gingival syndrome. A new form of erosive lichen planus. Int J Dermatol 1989; 28:381.
- Lopes Filho LL, Lopes IM, Lopes LR, et al. Mammary and extramammary Paget's disease. An Bras Dermatol 2015; 90:225.
- Sobel JD, Faro S, Force RW, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998; 178:203.
- Herbst R. Perineal streptococcal dermatitis/disease: recognition and management. Am J Clin Dermatol 2003; 4:555.
- Taylor JS, Praditsuwan P, Handel D, Kuffner G. Allergic contact dermatitis from doxepin cream. One-year patch test clinic experience. Arch Dermatol 1996; 132:515.
- Elmariah SB, Lerner EA. Topical therapies for pruritus. Semin Cutan Med Surg 2011; 30:118.
- Jones SM, Sampson HA. The role of allergens in atopic dermatitis. Clin Rev Allergy 1993; 11:471.
- 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.
- 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.
- 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.
- 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.
- 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.
- Black RJ. Vulval eczema associated with propolis sensitization from topical therapies treated successfully with pimecrolimus cream. Clin Exp Dermatol 2005; 30:91.
- www.fda.gov/cder/drug/infopage/protopic/default.htm (Accessed on January 10, 2008).
- 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.
- 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.
- American Academy of Dermatoloty. Atopic dermatitis clinical guideline. https://www.aad.org/practice-tools/quality-care/clinical-guidelines/atopic-dermatitis (Accessed on February 03, 2016).
- ENDOGENOUS VERSUS EXOGENOUS DERMATITIS
- CLINICAL MANIFESTATIONS
- Physical examination
- Patch testing
- DIFFERENTIAL DIAGNOSIS
- Inflammatory vulvar dermatoses
- Vulvar intraepithelial neoplasia
- Vulvar cancer
- Paget disease (extramammary)
- Vulvar pain syndromes
- Vulvovaginal atrophy
- General measures
- Diagnosis and treatment of coexistent infection
- Control of pruritus
- Patients with mild symptoms
- Patients with moderate to severe symptoms
- - Corticosteroid-dependent vulvar dermatitis
- Patients with severe refractory disease
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS