Last edited 06/2018
Treatment is dependent on cause.
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 innerware 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-scrath-itch cycle and to prevent the patient from night scratching:
- sedative antihistamines - diphenhydramine (25-50mg) or hydroxyzine (12.5-25mg)
- agents with antidepressive effects such as amytriptyline (25mg upto 100mg) can be used (1) - amytriptyline 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, sertaline, fluvoxamine mirtazapine and citalopram may be beneficial (1)