management

Last edited 06/2018

treatment

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)

Reference:

• (1) Swamiappan M. Anogenital Pruritus An Overview. Journal of Clinical and Diagnostic Research: JCDR. 2016;10(4):WE01-WE03