First of all an accurate diagnosis is crucial as treating itch depends on identifying and removing the cause. The aims of treatment are to control or stop the symptom of itch, disease activity and reduce inflammation. It should be noted that many conditions are chronic and expectation of cure should be realistic.
Whatever the cause, these general guidelines should be followed to minimise/prevent the symptoms:
- Avoid irritants and aggravating factors -- many topical agents can be irritating
- Avoid over washing and pay attention to hygiene
The sensation of itching is heightened if the skin is warm. Patients should therefore take measures to cool the skin, including having tepid showers, wearing light clothes that absorb sweat and avoiding over heated rooms where appropriate
Emollients and Moisturisers
- Restrict time in the shower or bath
- Apply moisturisers immediately after bathing
- Avoid wearing wool or tight clothing
- Avoid cleansers containing alcohol
- Use a barrier cream or ointments e.g. zinc if there is incontinence or sweating, they help the skin to retain water
- Avoid rapid changes in environmental humidity
- Avoid hot or spicy foods
- Avoid alcohol
Specific treatment will be determined according to the cause. However, Emollients and Moisturisers
are a must. These act on the top layers of skin to soften, soothe, smooth and hydrate it. Dryness is an important remediable cause. Most common ones consist of soft paraffin or a combination of soft, liquid and hard paraffin. They should be used both as a soap substitute and to moisturise the skin to help restore and preserve the barrier function of skin. The effects are short lived so use frequently and liberally on a maintenance basis; 15-25gm a week with x 2 daily application to groins and vulva. You may try different ones but try and avoid those with dyes and fragrances even if the skin is clear. Smooth on, don’t rub in, and always apply in the direction of hair growth. Ointments are particularly suitable for dry, chronic lesions but may exacerbate acne and folliculitis.
If itching continues to be a problem despite treatment, there are a number of drugs available to use - however, these should always be discussed with a doctor before using.
Read further about the common causes of vulval itch
See section on abnormal vaginal discharge.
Generalized skin disease can affect the vulva as part of the process but there are a number of conditions which are more specifically localized to vulval skin. These are grouped together under the term vulval dermatoses. They share some characteristics and yet have their own distinct features. Treatment of all these conditions relies on a precise diagnosis.
vulval eczema may occur on its own or be part of a more widespread disease. It frequently affects the vulva and is a common cause of itch which has often been mistakenly ascribed to a thrush infection. There are a number of subtypes with different underlying causes. Atopic eczema occurs in people with a strong family history and in those with asthma and hay fever. Medicaments and perfumes are major causes of contact irritant dermatitis (eczema), which is very common on the vulva and may cause an acute eczema. Contact allergic dermatitis may be caused by an underlying allergy to e.g. lanolin or latex and may need to be excluded. Although it is a lifelong chronic condition with proper treatment, good control can be achieved.
lichen simplex is a very common cause of vulval itch and can be very severe. The skin thickens as a result of scratching and the skin barrier is not working properly. Like eczema, the itch is often mistakenly ascribed to a thrush infection. Of course both may occur together and need the appropriate treatment. Strong steroids may be required. It can be chronic with flares and recurrences.
In lichen sclerosus, the skin becomes thin, brittle and often appears white and wrinkled. Although the cause is unknown, the skin is damaged by the immune system. About ¼ of women will have another immune condition such as thyroid disease. It can affect women of any age but is often not diagnosed early. It is important to get an accurate early diagnosis because if the disease is not controlled, noticeable scarring and damage can occur. There is also a small (5-10%) increased risk of developing a skin cancer, so long term follow up is recommended.
vulval psoriasis may occur on its own or be part of more widespread disease. The classic appearance of psoriasis is lost on the vulva making diagnosis more difficult. When only the vulva is affected, accurate and early diagnosis is important so that if disease develops elsewhere it can all be managed correctly. Many of the standard treatments used are too irritating on vulval skin. It is a lifelong chronic condition.