Contact Vulvitis

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Chapter 69 Contact Vulvitis

INTRODUCTION

Description: Contact vulvitis is characterized by vulvar irritation caused by contact with an irritant or allergen.

Prevalence: Relatively common.

Predominant Age: Any, but most common in reproductive and menopausal years.

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Irritants may be primary or immunologic in character. The list of potential irritants can be extensive, including “feminine hygiene” sprays, deodorants and deodorant soaps, tampons or pads (especially those with deodorants or perfumes), tight-fitting undergarments or those made of synthetic fabric, colored or scented toilet paper, and laundry soap or fabric softener residues. Even topical contraceptives, latex condoms, lubricants, “sexual aids,” or semen may be the source of irritation. Soiling of the vulva by urine or feces can also create significant symptoms. Severe dermatitis of the vulva resulting from contact with poison ivy or poison oak is found occasionally.

Risk Factors: Exposure to allergen (most often cosmetic or local therapeutic agents), immunosuppression, or diabetes.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Diffuse reddening of the vulvar skin accompanied by itching or burning

• Symmetric, red, edematous change in the tissues

• Ulceration with weeping sores and secondary infection possible

DIAGNOSTIC APPROACH

Workup and Evaluation

Laboratory: Examination of vaginal secretions under saline and 10% KOH (potassium hydroxide) to rule out possible vaginal infection.

Imaging: No imaging indicated.

Special Tests: Vulvar biopsy rarely required, although it may be diagnostic.

Diagnostic Procedures: A careful history, combined with the withdrawal of the suspected cause, usually both confirms the diagnosis and constitutes the needed therapy.

Pathologic Findings

Vulvar biopsy shows chronic inflammatory change and infiltration by histiocytes.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Perineal hygiene (keep the perineal area clean and dry; avoid tight undergarments or those made of synthetic fabric); education regarding prevention; encourage completion of the prescribed course of therapy.

Specific Measures: Removal of identified (or possible) allergens, topical therapy.

Diet: No specific dietary changes indicated.

Activity: No restriction.

Patient Education: Reassurance, education about avoidance or risk reduction; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP088 (Disorders of the Vulva).

Drug(s) of Choice

Wet compresses or soaks using Burow’s solution (aluminum acetate 2.5% to 5% solution, three to four times daily for 30 to 60 minutes), followed by air drying or drying with a hair dryer (on cool setting). (Loose-fitting clothing and the sparing use of a nonmedicated baby powder may facilitate the drying process.)

Steroid creams (hydrocortisone 0.5% to 1%) or fluorinated corticosteroids (Valisone 0.1%, Synalar 0.01%) applied two to three times a day if needed.

Precautions: Further evaluation is warranted (including biopsy) if initial therapy does not produce significant improvement.

Alternative Drugs

Eucerin cream may be used to rehydrate the skin and reduce itching.

FOLLOW-UP

Patient Monitoring: Normal health maintenance.

Prevention/Avoidance: Avoidance of possible allergens.

Possible Complications: Excoriation, chronic vulvar change (thickening).

Expected Outcome: With removal of causative agent, complete resolution should be expected.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy.

ICD-9-CM Codes: 616.10.

Chang TW. Familial allergic seminal vulvovaginitis. Am J Obstet Gynecol. 1976;126:442.

Fisher AA. Allergic reaction to feminine hygiene sprays. Arch Dermatol. 1973;108:801.

Moraes PS. Allergic vulvovaginitis induced by house dust mites: a case report. J Allergy Clin Immunol. 1998;101:557.

Nyirjesy P, Peyton C, Weitz MV, et al. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol. 2006;108:1185.

Rigg D, Miller MM, Metzger WJ. Recurrent allergic vulvovaginitis: treatment with Candida albicans allergen immunotherapy. Am J Obstet Gynecol. 1990;162:332.

Witkin SS, Jeremias J, Ledger WJ. A localized vaginal allergic response in women with recurrent vaginitis. J Allergy Clin Immunol. 1988;81:412.

American College of Obstetricians and Gynecologists. Vaginitis. ACOG Practice Bulletin 72. Obstet Gynecol. 2006;107:1195.

McKay M. Vulvar dermatoses. Clin Obstet Gynecol. 1991;34:614.

McKay M. Vulvitis and vulvovaginitis: cutaneous considerations. Am J Obstet Gynecol. 1991;165:1176.

Nanda VS. Common dermatoses. Am J Obstet Gynecol. 1995;173:488.

Smith RP. Gynecology in primary care. Baltimore: Williams & Wilkins, 1997;603.

Summers P. Vaginitis in 1993. Clin Obstet Gynecol. 1993;36:105.

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