Vulvar Dermatitis - Causes, Features, Diagnosis, and Treatment

Introduction:

The female reproductive system has its unique structure and functions to perform. Therefore, before knowing about the infectious condition of the vulva, it is vital to understand the structure of the vulva. In addition, maintaining its hygiene is crucial to prevent unnecessary infection and inflammation.

The vulva belongs to the external genitalia of the female, and it includes:

• Mons pubis.

• Labia majora.

• Labia minora.

• Clitoris.

• Perineum.

Several conditions may occur in the vulva: dermatitis, folliculitis, lichen planus, etc. This article reviews in detail about vulvar dermatitis.

What Is Vulvar Dermatitis?

Dermatitis is a common skin condition, and when it involves the vulva, it is termed vulvar dermatitis. The affected vulva appears dry and is itchy and provides discomfort. In addition, vulvar dermatitis more commonly occurs in females with low levels of estrogen, especially postmenopausal women or young girls who have not attained puberty yet. Low estrogen levels make the vulva dry, predisposing them to infections, injury, etc.

How Is Vulvar Dermatitis Caused?

Skin is a protective barrier that prevents various injuries, infections, etc. However, the external genitalia is very delicate, leading to increased injury. In addition, the components that cause itchiness or dryness of the vulva leading to dermatitis, are listed down:

• Using harsh soaps to wash the vulvar region.

• Wet wipes or toilet paper.

• Hair shampoo and conditioner.

• Sanitary napkins.

• Perfumes or talcum powders.

• Nylon or other synthetic underwear.

• Detergents.

• Tea tree oil.

• The risk of vulvar dermatitis is high when the vulva is frequently contacted and irritated with urine or fecal matter due to conditions like urine or fecal incontinence.

What Are the Features of Vulvar Dermatitis?

The typical features of vulvar dermatitis are listed down:

• Itching and burning sensation.

• The vulva seems to be red and swollen.

• Increased pain during sexual intercourse or tampon and speculum (during pelvic investigation) insertion.

• Women may also feel wetness in their vulva, as it is irritated.

• The irritated skin along the vulva remains inflamed and thick compared to the surrounding skin.

• Flare-ups are also common.

How Is Vulvar Dermatitis Diagnosed?

The techniques or methods that aid in diagnosing vulvar dermatitis are as follows:

• Whenever a patient complains of any discomfort or pain in the genitals, the doctors usually start their examination by enquiring the patient more about their presenting complaint. It also includes the current and past medications, history of any illness, surgery, allergic reactions or autoimmune disorders, etc. In addition, it is the patient's responsibility to clearly describe the genital hygiene followed by them to help the doctor discover the real cause of the condition.

• Genital Examination - The specialist might start examining the vulvar and vaginal areas to know the severity of the infection. They may also inspect the signs of vulvar dermatitides, such as redness, swelling, etc.

• Vaginal Discharge - The vaginal discharge greatly helps the doctor evaluate the condition; further, it also provides insights on the type of infection, bacterial or fungal.

• Allergy Skin Test - The doctor may also order a patch test to identify whether any allergen has caused vulvar dermatitis and to find the type of allergen. The doctor may apply diluted allergens over the skin and check for any reaction after 48 hours.

• Biopsy - The doctor may not usually suggest a biopsy for vulvar dermatitis, but if the condition is severe and does not respond to any treatment, then a biopsy may help. Therefore, a sample of tissue from the lesion is surgically excised to evaluate and distinguish it from other severe conditions of the vulva, such as cancer, dysplasia, etc.

What Are Other Diseases of the Vulva?

It is essential to know the following conditions and to differentiate them from vulvar dermatitis for further treatment.

• Vulvitis - Due to allergic reactions or infections, the vulva gets inflamed, known as vulvitis. The symptoms like redness, itching, and vaginal discharge are similar to vulvar dermatitis. Therefore, the doctor may order a urine or blood examination to evaluate infection.

• Lichen Planus is rare, and red and white lines are formed over the vulva. In addition, women affected with lichen planus may have pain during sexual intercourse, and the lesion keeps recurring.

• Psoriasis - Scaly patches may accumulate over the genital area, which injuries, stress, infections, etc., may trigger. It also results in pain, burning, and itching sensation and the doctor may easily diagnose psoriasis through physical examination.

• Vulvar Cancer - Vulvar cancer may also cause itching and causes bleeding, pain, and a lump or ulcer over the vulva. Therefore, a biopsy and a PAP (Papanicolaou) smear test are crucial to diagnosing vulvar cancer.

How to Get Rid of Vulvar Dermatitis?

Yes, it is possible to get rid of such conditions through:

1) Things One Should Follow at Home

• Maintain proper hygiene of the genitals.

• Avoid using tight-fitting and synthetic undergarments.

• Avoid using triggering factors or elements (perfumes, hygiene products, etc.) that irritate the vulva.

• Clean the vulva gently with warm water and mild soap, do not scrub the vulva.

• Pat dry the vulva with a soft and clean towel.

• In addition, it is crucial to wash the undergarments and other fabric using mild and unscented detergents.

• Do not shave the hair on the vulva, especially when you have an active infection.

• Use non-irritating and cotton pads to prevent triggering inflammation.

2) Other Treatments

As itching and burning sensation remain to be the main concern of patients with vulvar dermatitis, the following may be suggested:

• Drugs to soothe itching, such as Doxepin and Hydroxyzine, may be suggested to relieve itching.

• The doctor also recommends creams and lotions containing urea and lauromacrogols to treat itching and burning sensations, which will prevent scratching.

Is Vulvar Dermatitis Permanent?

It depends on the underlying cause of vulvar dermatitis. When allergens trigger dermatitis, staying away from these triggering factors may prevent the recurrence of vulvar dermatitis. But in case of any infection, the condition is also treatable but may take longer.

Conclusion:

Vulvar dermatitis may be a common condition, but it is not serious. Therefore, following proper genital hygiene and knowing the allergens may help prevent vulvar dermatitis. In addition, one should not feel ashamed or embarrassed to convey their genital issues or problems to a specialist to prevent further complications.