Source: Vulvovaginal Dermatology – Dermatology Clinics
Contact Dermatitis of the Vulva

Figures

Two types: Irritant (ICD) and Allergic Contact Dermatitis (ACD)

Common vulvar irritants

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Common vulvar allergens

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Clinical differential diagnosis of ICD and ACD

Prescription

Topical corticosteroid ointment:

• hydrocortisone 2.5%, or
• triamcinolone acetonide 0.1%, or
• clobetasol propionate 0.05%, or
• halobetasol 0.05%

Systemic corticosteroids:

• Prednisone 40 –  60 mg daily in the morning (0.5 – 1.0mg/kg/d ideal body weight) with gradual tapering over 14 to 21 days
• Triamcinolone acetonide IM 1 mg/kg as a single dose

Systemic prophylaxis for candidiasis

• Fluconazole 150 mg PO weekly for all patients treated with topical or systemic corticosteroids

Treatment pruritus / scratching by combination of nonsedating and sedating antihistamines

• In morning: Loratadine 10 mg or Fexofenadine 60 mg or Cetirizine 10 mg, 1-2 times/d
• In evening: Hydroxyzine 25-100 mg, doxepin 10-75 mg

Treat secondary infection with systemic antibiotics, associated with prophylaxis for secondary vulvovaginal candidiasis using fluconazole 150 mg by mouth once weekly

Possible treatment of estrogen deficiency

Patient Education

• To discontinue all potential irritants and allergens
• To cleanse the vulva no more than twice daily using only lukewarm (not hot) water without soap, cleanser, or detergent
• To do sitz baths 5 10 minutes, in which the patient fills the tub with only lukewarm water to cover the hips and buttocks for cleansing the vulva and for relief of pain or itching
• To use a handheld shower spray can be used on a gentle setting for directed vulvar hygiene
• To to use only hands to clean the vulva and to discontinue the use of all washcloths, loofahs and sponges
• To pat the vulva dry, avoiding rubbing and additional friction
• To apply plain white petrolatum should be applied as an emollient and barrier for fissured or eroded areas
• To apply a copious layer of plain white petrolatum to all eroded areas before and after each bathroom use
• To urinate while seated in a shallow tube of lukewarm water or by pouring lukewarm water over the vulva during micturition for reducing dysuria
• To apply dilute aluminum acetate solutions for short periods as compresses to facilitate desiccation.
• To apply the prescribed topical corticosteroid ointment initially twice daily until lesions have healed completely
• To take medications as prescribed
• To avoid topic antipuritics (diphenhydramine, lidocaine)
• To avoid heat application
• To apply cool compresses, cool gel packs, or frozen vegetables wrapped in thin fabric