Treatment
Treatment is dependent on the cause. (1,2)
General measures include:
- avoidance of exacerbating factors such as sweat, occlusion, irritating cleaning habits and wiping should be always from front to back
- use of cotton instead of tight fitting synthetic materials
- tampons are recommended during menstruation (better than sanitary pads)
- cool compressors - to reduce itch
- topical or systemic antibiotics and astringent soaks like Burow's solution (aluminium acetate) - for oozing excoriated lesions
For nonspecific pruritus vulvae, topical steroids is the mainstay of treatment.
- begin with twice daily high potency steroid like clobetasol propionate 0.05.% then reduced to once daily and switched over to medium or mild potent steroids according to the response under strict monitoring
- prolonged use should be avoided
To break the itch-scratch-itch cycle and to prevent the patient from night scratching:
- sedative antihistamines - diphenhydramine (25-50mg) or hydroxyzine (12.5-25mg)
- agents with anti-depressant effects such as amitriptyline (25mg up to 100mg) can be used (1) - amitriptyline is particularly useful in anogenital itch having neuropathic qualities such as stinging or burning (1)
For intractable pruritus resistant to routine therapy;
- gabapentin and selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, fluvoxamine mirtazapine and citalopram may be beneficial (1)
Reference:
- Swamiappan M. Anogenital Pruritus An Overview. Journal of Clinical and Diagnostic Research: JCDR. 2016;10(4):WE01-WE03
- Moyal-Barracco M, Wendling J. Vulvar dermatosis. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28(7):946-58.