Skip to main content
SpringerLink
Log in

Pruritus Vulvae

  • Chapter
  • First Online:
Pruritus

  • 1035 Accesses

Abstract

Pruritus vulvae is a common motive of consultation both in gynaecological and vulvar clinics. As opposed to vulvar pain which may occur in the absence of visible findings (vulvodynia), pruritus vulvae is almost always associated with visible lesions related to specific conditions. An etiological diagnosis is mandatory if we are to appropriately inform and efficiently treat the patient. The age of the patient, the chronology of pruritus (acute, chronic, recurrent), the response to previous treatments (antifungal, corticosteroid), the location and the aspect of the lesions will all help assessing, or at least orienting, the specific diagnosis. Diagnostic tests such as vulvovaginal specimens looking for infections, or biopsies are indicated in case of recurrent or chronic itch. This chapter focuses on the diagnosis and the treatment of the most common causes of pruritus vulvae (mainly yeast infections, lichen simplex chronicus, lichen sclerosus, lichen planus, psoriasis). It also deals with intraepithelial neoplasias and Paget’s disease which, although rarer, should be diagnosed as early as possible because they are potential precursors of invasive vulvar cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bohl TG. Overview of vulvar pruritus through the life cycle. Clin Obstet Gynecol. 2005;48:786–807.

    Article  PubMed  Google Scholar 

  2. Bornstein J, Bogliatto F, Haefner HK, Stockdale CK, Preti M, Bohl TG, Reutter J, ISSVD Terminology Committee. The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions. J Low Genit Tract Dis. 2016;20(1):11–4.

    Article  PubMed  Google Scholar 

  3. Bougrine A, Villeneuve-Tang C, Bouffard D, Rouleau D, Chartier S. Kerion of the vulva caused by Trichophyton mentagrophytes. J Cutan Med Surg. 2014;18(3):206–9.

    PubMed  Google Scholar 

  4. Carlson JA, Ambros R, Malfetano J, Ross J, Grabowski R, Lamb P, Figge H, Mihm Jr MC. Vulvar lichen sclerosus and squamous cell carcinoma: a cohort, case control, and investigational study with historical perspective; implications for chronic inflammation and sclerosis in the development of neoplasia. Hum Pathol. 1998;29:932–48.

    Article  CAS  PubMed  Google Scholar 

  5. Centers for Disease Control and Prevention. Pinworms. Available at http://www.cdc.gov/parasites/pinworm/epi.html. Accessed 17 June 2013.

  6. Centers for Disease Control and Prevention. 2015 STD Treatment Guidelines – Genital HSV Infections http://www.cdc.gov/std/tg2015/herpes.html. Accessed 4 June 2015.

  7. Chang SE, Lee DK, Choi JH, Moon KC, Koh JK. Majocchi’s granuloma of the vulva caused by Trichophyton mentagrophytes. Mycoses. 2005;48(6):382–4.

    Article  CAS  PubMed  Google Scholar 

  8. Cheng S, Kirtschig G, Cooper S, Thornhill M, Leonardi-Bee J, Murphy R. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev. 2012;(2):CD008092.

    Google Scholar 

  9. Clegg HW, Giftos PM, Anderson WE, Kaplan EL, Johnson DR. Clinical perineal streptococcal infection in children: epidemiologic features, low symptomatic recurrence rate after treatment, and risk factors for recurrence. J Pediatr. 2015;167(3):687–93.

    Article  PubMed  Google Scholar 

  10. Cooper SM, Gao XH, Powell JJ, Wojnarowska F. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. 2004;140:702–6.

    Article  CAS  PubMed  Google Scholar 

  11. Cooper SM, Ali I, Baldo M, et al. The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case-control study. Arch Dermatol. 2008;144:1432–5.

    PubMed  Google Scholar 

  12. Delport ES. Extramammary Paget’s disease of the vulva: an annotated review of the current literature. Australas J Dermatol. 2013;54(1):9–21.

    Article  PubMed  Google Scholar 

  13. Dereli T, Turk BG, Kazandi AC. Syringomas of the vulva. Int J Gynaecol Obstet. 2007;99:65–6.

    Article  CAS  PubMed  Google Scholar 

  14. Edgardh K. Experiences with a special vulvar clinic in Oslo. Tidsskr Nor Laegeforen. 2005;125(8):1026–7.

    PubMed  Google Scholar 

  15. Fehr MK, Baumann M, Mueller M, Fink D, Heinzl S, Imesch P, Dedes K. Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia. J Gynecol Oncol. 2013;24(3):236–41.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013;14:27–47.

    Article  PubMed  Google Scholar 

  17. Foggia L, Hovnanian A. Calcium pump disorders of the skin. Med Genet C Semin Med Genet. 2004;131C:20–31.

    Article  Google Scholar 

  18. Foote CA, Brady SP, Brady KL, Clark NS, Mercurio MG. Vulvar dermatitis from allergy to moist flushable wipes. J Low Genit Tract Dis. 2014;18(1):E16–8.

    Article  PubMed  Google Scholar 

  19. Foxman B, Muraglia R, Dietz JP, Sobel JD, Wagner J. Prevalence of recurrent vulvovaginal candidiasis in 5 European countries and the United States: results from an internet panel survey. J Low Genit Tract Dis. 2013;17(3):340–5.

    Article  PubMed  Google Scholar 

  20. Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2015;21:1–23.

    Article  Google Scholar 

  21. Griffin JR, Davis MD. Amitriptyline/Ketamine as therapy for neuropathic pruritus and pain secondary to herpes zoster. J Drugs Dermatol. 2015;14(2):115–8.

    PubMed  Google Scholar 

  22. Hansen A, Carr K, Jensen JT. Characteristics and initial diagnoses in women presenting to a referral center for vulvovaginal disorders in 1996–2000. J Reprod Med. 2002;47(10):854–60.

    PubMed  Google Scholar 

  23. Helou J, Maatouk I, Moutran R, Obeid G. Fox-Fordyce-like disease following laser hair removal appearing on all treated areas. Lasers Med Sci. 2013;28(4):1205–7.

    Article  PubMed  Google Scholar 

  24. Hicks MI, Elston DM. Scabies. Dermatol Ther. 2009;22(4):279–92.

    Article  PubMed  Google Scholar 

  25. Ho D, Jagdeo J. Successful botulinum toxin (onabotulinumtoxinA) treatment of Hailey-Hailey disease. J Drugs Dermatol. 2015;14(1):68–70.

    PubMed  Google Scholar 

  26. Hoffstetter S, Barr S, LeFevre C, Gavard JA. Telephone triage: diagnosis of candidiasis based upon self-reported vulvovaginal symptoms. J Low Genit Tract Dis. 2012;16(3):251–5.

    Article  PubMed  Google Scholar 

  27. Jensen LS, Bygum A. Childhood lichen sclerosus is a rare but important diagnosis. Dan Med J. 2012;59:A4424.

    PubMed  Google Scholar 

  28. Johnston C, Corey L. Current concepts for genital herpes simplex virus infection: diagnostics and pathogenesis of genital tract shedding. Clin Microbiol Rev. 2016;29(1):149–61.

    Article  PubMed  Google Scholar 

  29. Jones RW, Sadler L, Grant S, et al. Clinically identifying women with vulvar lichen sclerosus at increased risk of squamous cell carcinoma: a case-control study. J Reprod Med. 2004;49:808–11.

    PubMed  Google Scholar 

  30. Kapila S, Bradford J, Fischer G. Vulvar psoriasis in adults and children: a clinical audit of 194 cases and review of the literature. J Low Genit Tract Dis. 2012;16(4):364–71.

    Article  PubMed  Google Scholar 

  31. Karam A, Dorigo O. Increased risk and pattern of secondary malignancies in patients with invasive extramammary Paget disease. Br J Dermatol. 2014;170(3):661–71.

    Article  CAS  PubMed  Google Scholar 

  32. Kavala M, Can B, Zindanci I, Kocatürk E, Türkoğlu Z, Büyükbabani N, Koç M. Vulvar pruritus caused by syringoma of the vulva. Int J Dermatol. 2008;47(8):831–2.

    Article  PubMed  Google Scholar 

  33. Kirtschig G, Becker K, Günthert A, Jasaitiene D, Cooper S, Chi CC, Kreuter A, Rall KK, Aberer W, Riechardt S, Casabona F, Powell J, Brackenbury F, Erdmann R, Lazzeri M, Barbagli G, Wojnarowska F. Evidence-based (S3) Guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol. 2015;29(10):e1–43.

    Article  CAS  PubMed  Google Scholar 

  34. Kjetland EF, Kurewa EN, Ndhlovu PD, Midzi N, Gwanzura L, Mason PR, Gomo E, Sandvik L, Mduluza T, Friis H, Gundersen SG. Female genital schistosomiasis—a differential diagnosis to sexually transmitted disease: genital itch and vaginal discharge as indicators of genital Schistosoma haematobium morbidity in a cross-sectional study in endemic rural Zimbabwe. Trop Med Int Health. 2008;13(12):1509–17.

    Article  PubMed  Google Scholar 

  35. Le Cleach L, Chosidow O. Clinical practice. Lichen Planus N Engl J Med. 2012;366(8):723–32.

    Article  PubMed  Google Scholar 

  36. Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women. JAMA Dermatol. 2015;151(10):1061–7.

    Article  PubMed  Google Scholar 

  37. Lisboa C, Costa AR, Ricardo E, Santos A, Azevedo F, Pina-Vaz C, Rodrigues AG. Genital candidosis in heterosexual couples. J Eur Acad Dermatol Venereol. 2011;25(2):145–51.

    Article  CAS  PubMed  Google Scholar 

  38. Lu B, Liang Y. Pagetoid spread of bladder urothelial carcinoma to the vagina and vulva. J Low Genit Tract Dis. 2015;19(1):e13–6.

    Article  PubMed  Google Scholar 

  39. Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004;17:8–19.

    Article  PubMed  Google Scholar 

  40. Machida H, Moeini A, Roman LD, Matsuo K. Effects of imiquimod on vulvar Paget’s disease: a systematic review of literature. Gynecol Oncol. 2015;139(1):165–71.

    Article  CAS  PubMed  Google Scholar 

  41. Manousaridis I, Manousaridis K, Peitsch WK, Schneider SW. Individualizing treatment and choice of medication in lichen planus: a step by step approach. J Dtsch Dermatol Ges. 2013;11:981–91.

    Google Scholar 

  42. Meites E, Gaydos CA, Hobbs MM, Kissinger P, Nyirjesy P, Schwebke JR, Secor WE, Sobel JD, Workowski KA. A review of evidence-based care of symptomatic trichomoniasis and asymptomatic trichomonas vaginalis infections. Clin Infect Dis. 2015;61 Suppl 8:S837–48.

    Article  PubMed  Google Scholar 

  43. Mendling W, Brasch J, Cornely OA, Effendy I, Friese K, Ginter-Hanselmayer G, Hof H, Mayser P, Mylonas I, Ruhnke M, Schaller M, Weissenbacher ER. Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneouscandidosis). Mycoses. 2015;58 Suppl 1:1–15.

    Article  CAS  PubMed  Google Scholar 

  44. Monsel G, Chosidow O. Management of scabies. Skin Therapy Lett. 2012;17(3):1–4.

    PubMed  Google Scholar 

  45. Moyal-Barracco M, Wendling J. Vulvar dermatosis. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):946–58.

    Article  PubMed  Google Scholar 

  46. Nagashima M, Yamagishi Y, Mikamo H. Antifungal susceptibilities of Candida species isolated from the patients with vaginal candidiasis. J Infect Chemother. 2016;22(2):124–6.

    Article  PubMed  Google Scholar 

  47. Nibhoria S, Tiwana KK, Yadav A. Vulvar syringoma: a rare case report. J Clin Diagn Res. 2014;8(8):FD06.

    PubMed  PubMed Central  Google Scholar 

  48. Nurbhai M, Grimshaw J, Watson M, et al. A. Oral versus intra-vaginalimidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev. 2007;(4):CD002845.

    Google Scholar 

  49. Nyirjesy P, Sobel JD. Genital mycotic infections in patients with diabetes. Postgrad Med. 2013;125(3):33–46.

    Article  PubMed  Google Scholar 

  50. O’Gorman SM, Torgerson RR. Allergic contact dermatitis of the vulva. Dermatitis. 2013;24(2):64–72.

    Article  PubMed  Google Scholar 

  51. O’Keefe RJ, Scurry JP, Dennerstein G, et al. Audit of 114 non-neoplastic vulvar biopsies. Br J Obstet Gynaecol. 1995;102:780–6.

    Article  PubMed  Google Scholar 

  52. Ozalp SS, Telli E, Yalcin OT, Oge T, Karakas N. Vulval pruritus: the experience of gynaecologists revealed by biopsy. J Obstet Gynaecol. 2015;35(1):53–6.

    Article  CAS  PubMed  Google Scholar 

  53. Paek SC, Merritt DF, Mallory SB. Pruritus vulvae in prepubertal children. J Am Acad Dermatol. 2001;44(5):795–802.

    Article  CAS  PubMed  Google Scholar 

  54. Paulitsch A, Weger W, Ginter-Hanselmayer G, Marth E, Buzina W. A 5-Year (2000–2004) epidemiological survey of Candida and noncandida yeasts species causing vulvovaginal candidiasis in Graz. Austria Mycoses. 2006;49:471–5.

    Article  CAS  PubMed  Google Scholar 

  55. Pierie JP, Choudry U, Muzikansky A, Finkelstein DM, Ott MJ. Prognosis and management of extramammary Paget’s disease and the association with secondary malignancies. J Am Coll Surg. 2003;196(1):45–50.

    Article  PubMed  Google Scholar 

  56. Preti M, Scurry J, Marchitelli CE, Micheletti L. Vulvar intraepithelial neoplasia. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1051–62.

    Article  PubMed  Google Scholar 

  57. Schlosser BJ. Contact dermatitis of the vulva. Dermatol Clin. 2010;28(4):697–706.

    Article  CAS  PubMed  Google Scholar 

  58. Scott GR, Chosidow O, IUSTI/WHO. European guideline for the management of pediculosis pubis, 2010. Int J STD AIDS. 2011;22(6):304–5.

    Article  CAS  PubMed  Google Scholar 

  59. Shaco-Levy R, Bean SM, Vollmer RT, Jewell E, Jones EL, Valdes CL, Bentley RC, Selim MA, Robboy SJ. Paget disease of the vulva: a study of 56 cases. Eur J Obstet Gynecol Reprod Biol. 2010;149(1):86–91.

    Article  PubMed  Google Scholar 

  60. Sherman V, McPherson T, Baldo M, et al. The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study. J Eur Acad Dermatol Venereol. 2010;24:1031–4.

    CAS  PubMed  Google Scholar 

  61. Sherrard J, Ison C, Moody J, Wainwright E, Wilson J, Sullivan A. United Kingdom National Guideline on the Management of Trichomonas vaginalis 2014. Int J STD AIDS. 2014;25(8):541–9.

    Article  PubMed  Google Scholar 

  62. Shihadeh AS, Nawafleh AN. The value of treating the male partner in vaginal candidiasis. Saudi Med J. 2000;21(11):1065–7.

    CAS  PubMed  Google Scholar 

  63. Sideri M, Jones RW, Wilkinson EJ, Preti M, Heller DS, Scurry J, Haefner H, Neill S. Squamous vulvar intraepithelial neoplasia: 2004 modified terminology, ISSVD Vulvar Oncology Subcommittee. J Reprod Med. 2005;50(11):807–10.

    PubMed  Google Scholar 

  64. Simpson RC, Thomas KS, Leighton P, Murphy R. Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise. Br J Dermatol. 2013;169(2):337–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Simpson RC, Thomas KS, Murphy R. Vulval erosive lichen planus: a qualitative investigation of U.K. clinician views and principles of management. Br J Dermatol. 2013;169(1):226–7.

    Article  CAS  PubMed  Google Scholar 

  66. Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, Sperling M, Livengood 3rd C, Horowitz B, Von Thron J, Edwards L, Panzer H, Chu TC. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004;351(9):876–83.

    Article  CAS  PubMed  Google Scholar 

  67. Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016;214(1):15–21.

    Article  PubMed  Google Scholar 

  68. Suzuki V, Haefner HK, Piper CK, O’Gara C, Reed BD. Postoperative sexual concerns and functioning in patients who underwent lysis of vulvovaginal adhesions. J Low Genit Tract Dis. 2013;17(1):33–7.

    Article  PubMed  Google Scholar 

  69. Tan AL, Jones R, Mcpherson G, Rowan D. Audit of a multidisciplinary vulvar clinic in a gynecologic hospital. J Reprod Med. 2000;45(8):655–8.

    CAS  PubMed  Google Scholar 

  70. Varela JA, Otero L, Espinosa E, et al. Phthirus pubis in a sexually transmitted diseases unit: a study of 14 years. Sex Transm Dis. 2003;30:292–6.

    Article  PubMed  Google Scholar 

  71. van de Nieuwenhof HP, Massuger LF, van der Avoort IA, Bekkers RL, Casparie M, Abma W, van Kempen LC, de Hullu JA. Vulvar squamous cell carcinoma development after diagnosis of VIN increases with age. Eur J Cancer. 2009;45(5):851–6.

    Article  PubMed  Google Scholar 

  72. van de Nieuwenhof HP, Bulten J, Hollema H, Dommerholt RG, Massuger LF, van der Zee AG, de Hullu JA, van Kempen LC. Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma. Mod Pathol. 2011;24(2):297–305.

    Article  PubMed  Google Scholar 

  73. van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2009;(4):CD004767.

    Google Scholar 

  74. van Esch EM, Dam MC, Osse ME, Putter H, Trimbos BJ, Fleuren G, van der Burg SH, van Poelgeest MI. Clinical characteristics associated with development of recurrence and progression in usual-type vulvar intraepithelial neoplasia. Int J Gynecol Cancer. 2013;23(8):1476–83.

    Article  PubMed  Google Scholar 

  75. van Seters M, van Beurden M, de Craen AJ. Is the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322 published patients. Gynecol Oncol. 2005;97(2):645–51.

    Article  PubMed  Google Scholar 

  76. Verkaeren E, Epelboin L, Epelboin S, Boddaert N, Brossier F, Caumes E. Recurrent Streptococcus pyogenes genital infection in a woman: test and treat the partner! Int J Infect Dis. 2014;29:37–9.

    Article  PubMed  Google Scholar 

  77. von Felbert V, Hampl M, Talhari C, Engers R, Megahed M. Squamous cell carcinoma arising from a localized vulval lesion of Hailey-Hailey disease after tacrolimus therapy. Am J Obstet Gynecol. 2010;203(3):e5–7.

    Article  Google Scholar 

  78. Wakashin K. Sanitary napkin contact dermatitis of the vulva: location-dependent differences in skin surface conditions may play a role in negative patch test results. J Dermatol. 2007;34:834–7.

    Article  PubMed  Google Scholar 

  79. Wallace HJ. Lichen sclerosus and atrophicus. Trans St John’s Hop Dermatol Soc. 1971;57:9–30.

    CAS  Google Scholar 

  80. Wilkinson EJ, Brown HM. Vulvar Paget disease of urothelial origin: a report of three cases and a proposed classification of vulvar Paget disease. Hum Pathol. 2002;33(5):549–54.

    Article  PubMed  Google Scholar 

  81. Yost J, Robinson M, Meehan SA. Fox-Fordyce disease. Dermatol Online J. 2012;18(12):28.

    PubMed  Google Scholar 

  82. Zamirska A, Reich A, Berny-Moreno J, Salomon J, Szepietowski JC. Vulvar pruritus and burning sensation in women with psoriasis. Acta Derm Venereol. 2008;88(2):132–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Tarnier-Cochin, 89 rue d’Assas, 75006, Paris, France

    Micheline Moyal-Barracco MD

Authors
  1. Micheline Moyal-Barracco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Micheline Moyal-Barracco MD .

Editor information

Editors and Affiliations

  1. Department of Dermatology, University of Brest, Brest, France

    Laurent Misery

  2. Center of Chronic Pruritus, University Hospital Münster, Münster, Nordrhein-Westfalen, Germany

    Sonja Ständer

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag London

About this chapter

Cite this chapter

Moyal-Barracco, M. (2016). Pruritus Vulvae. In: Misery, L., Ständer, S. (eds) Pruritus. Springer, Cham. https://doi.org/10.1007/978-3-319-33142-3_43

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33142-3_43

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33140-9

  • Online ISBN: 978-3-319-33142-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation