Name
PRURITIS VULVAE
DESCRIPTION
DETAIL
CAUSES: 1. AS A RESULT OF GENERALISED PRURITIS - SENILE ASTEATOSIS - LIVER: OBSTRUCTIVE HEPATOPATHY, LIVER SECONDARIES - KIDNEY : RENAL FAILURE , HYPERPARATHYROIDISM - BLOOD : POLYCYTHEMIA, ANEMIA: IRON DEFICIENCY - ENDOCRINE : HYPERTHYROIDISM, MYXOEDEMA - LYMPHOMA , T-CELL LEUKEMIA - PREGNANCY: LAST TRIMESTER - PSYCHOLOGICAL : DELUSIONAL STATE OF PARASITOSIS - DRUGS: GOLD SALTS, DETERGENTS, DE-GREASING AGENTS - CUTANEOUS SYPHILIS - ALLERGY 2. DUE TO LOCALISED SKIN DISEASE - SCABIES , LICE , INSECT BITES - DERMATITIS - LICHEN PLANUS - PRICKLY HEAT - URTICARIA - DERMATITIS HERPETIFORMIS - PEMPHIGOID GESTATIONIS - CUTANEOUS T-CELL LYMPHOMA - ONCHOCERCIASIS - FUNGAL INFECTION - CANDIDIASIS - TRICHOMONIASIS - POSTMENOPAUSAL VAGINAL ATROPHY - CARCINOMA IN SITU - PAGETS DISEASE - CHRONIC VULVAL DYSTROPHIES -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ The diagnosis of primary idiopathic vulvar pruritus must be made by exclusion β’ A search for infectious causes should be undertaken with treatment of yeast and other vaginitis β’ Biopsy of any abnormal-appearing epithelium on the vulva to insure that malignant changes are not present β’ Only when all other factors have been ruled out can the diagnosis primary idiopathic vulvar pruritus be establishedβ’ Vaginal secretions can be evaluated by wet mount (NaCl for trichomonas or Gardnerella, and KOH for yeast). Cultures seldom required. β’ Gram stain of the vagina is non-diagnostic as multiple organisms are present in the normal flora DIAGNOSTIC PROCEDURES Whenever necessary, biopsy of the vulva should be used to establish the primary diagnosis
TYPENOTES
GENERAL MEASURES β’ Treatment of any underlying cause must be undertaken β’ In cases of idiopathic primary vulvar pruritus, conservative measures include sitz baths, topical steroid creams, avoidance of chemical irritants and dietary changes β’ When conservative measures fail, advanced cases can be treated with alcohol block or laser SURGICAL MEASURES Bowen disease and premalignant changes are treated with excision or laser vaporization DIET A trial of dietary alteration should be attempted for idiopathic pruritus. Coffee and caffeinecontaining beverages should be avoided. Other foods to avoid include tomatoes, peanuts. DRUG(S) OF CHOICE β’ Infectious sources should be treated with appropriate antimicrobials or antifungals β’ Lichen sclerosis is treated with 2% testosterone in petrolatum β’ Hyperkeratotic lesions are treated with topical steroid β’ Idiopathic primary vulvar pruritus can be treated with topical steroids such as triamcinolone (Kenalog) or desoximetasone (Topicort) cream PATIENT MONITORING These women should be followed closely for the development of premalignant or malignant changes within the area of pruritus PREVENTION/AVOIDANCE β’ Irritants to the vulva such as perfumes, soaps (use nonallergenic) or perfume douches must be avoided β’ Only cotton underwear should be worn β’ No tight fitting clothes or nylon pantyhose POSSIBLE COMPLICATIONS Chronic course EXPECTED COURSE/PROGNOSIS β’ Vulvar pruritus can be kept under control with conservative measures and topical steroids β’ When it advances to uncontrollable symptoms, alcohol block or laser may be necessary
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
ABSOLUTE EOSINOPHIL COUNT, BLOOD UREA, URINE ROUTINE, PAP"S SMEAR, ULTRA SOUND OBSTETRICS, COMPLETE BLOOD COUNT, KOH PREPARATION FOR FUNGUS, PUS CULTURE TEST, BIOPSY, BLOOD SUGAR ( RANDOM )