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Is Atopy to Blame for Chronic Vulvitis?

Is Atopy to Blame for Chronic Vulvitis?

Several of my female patients have chronic itchy, burning vulvitis. Oral and topical antifungal agents, topical corticosteroids, and estrogen vaginal preparations have not been effective. The mucous membranes and perineal areas usually appear normal, except for scratch marks. Generally, results of potassium hydroxide evaluations are negative. How often does atopic dermatitis affect the vulva? I have prescribed doxepin; however, one patient complained of sleepiness. What can be done about this side effect?
-- L. Van Houten, ARNP
    Lake City, Fla
Chronic pruritus of the vulva is a challenging problem, and a full discussion lies outside the scope of this response. To treat burning vulvitis effectively, it is necessary to know the cause. When no obvious cause is evident, an extensive history taking, physical examination, and laboratory studies are required, and a multidisciplinary approach that involves dermatologic, genitourinary, and gynecologic consultations may be useful.1 Atopic dermatitis can affect the vulva, but it is an uncommon cause of chronic vulvar pruritus in postpubertal females. However, patients with sensitive skin are more likely than patients without a history of atopy to develop contact or irritant dermatitis as a reaction to hygienic products, clothing, detergents, fabric softeners, and so forth. Often, the source of the burning sensation cannot be identified. In such cases, symptomatic treatment is unfortunately the best that can be offered for this frustrating problem. Both topical and systemic treatments can provide symptomatic relief; however, avoid sensitizing medications, such as topical benzocaine. Doxepin is an effective antipruritic that should be reserved for bedtime use because of its soporific properties.
-- David L. Kaplan, MD
    University of Missouri, Kansas City
    University of Kansas

 
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