Vulvar Dermatitis - Causes, Features, Diagnosis, and Treatment

Introduction:

The female reproductive system has a unique structure and function. Therefore, it is vital to understand the structure of the vulva before learning about its infectious condition. 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 (skin irritation), folliculitis (inflamed hair follicles), lichen planus (chronic inflammatory autoimmune disease), etc. This article reviews vulvar dermatitis, including its causes, symptoms, diagnosis, and treatment.

What Is Vulvar Dermatitis?

Dermatitis is a common skin condition, and when it involves the vulva, termed vulvar dermatitis. The affected vulva appears dry and itchy and causes 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 below:

• Harsh soaps are used 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 (when there is leakage of stools).

What Is the Difference Between Dermatitis and Herpes?

Herpes and dermatitis are different medical disorders with different reasons for occurrence and clinical features. Herpes is a viral infection, and the reason for its occurrence is the herpes simplex virus. Dermatitis is a skin condition that occurs due to several irritants, such as soap, detergents, and solvents. In herpes, painful ulcers may appear that rupture and ooze. In the case of dermatitis, the person may experience itching, dry skin, cracked skin, rash, and thickened skin.

Who Is Affected by Vulvar Dermatitis?

The condition affects people of all ages. However, people who are affected by vulvar dermatitis are as follows:

• Postmenopausal women.

• People who have not gone through puberty.

What Are the Clinical Features of Vulvar Dermatitis?

The typical features of vulvar dermatitis are listed below:

• 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:

• Patient History - Whenever a patient complains of any discomfort or pain in the genitals, the doctors usually start their examination by asking the patient more about their presenting complaint. It also includes the current and past medications, history of any illness, surgery, allergic reactions, 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 dermatitis, 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 determine the type of allergen. The doctor may apply diluted allergens to 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 (development of abnormal cell growth), 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: Lichen Planus is rare and forms red and white lines 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 sensations, and the doctor may easily diagnose psoriasis through physical examination.

• Vulvar Cancer -Vulvar cancer may also cause itching, 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?

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, but do not scrub it.

• 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 an individual has an active infection.

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

2) Other Treatments

As itching and burning sensations remain the main concerns 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. However, 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, proper genital hygiene and knowledge of 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. Preventive measures include loose clothing, use of condoms, and keeping the genital area dry and clean. The prognosis of vulvar dermatitis is good with proper treatment.