Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach
Woelber L, Prieske K, Mendling W, Schmalfeldt B, Tietz HJ, Jaeger A. · Deutsches Arzteblatt International · 2020 February 21
DOI 10.3238/arztebl.2020.0126
Objective
This review is based on pertinent publications that were retrieved by a selective search in MEDLINE/PubMed for articles on the pathogenesis, diagnosis, and treatment of vulvar pruritus. The search terms were (in German and English) “vulvärer Juckreiz,” “pruritus vulvae,” and “genital itch,” alone and in combination with “Behandlung,” “Therapie,” or “treatment.”
Conclusions
As vulvar pruritus has multiple causes, standardization of its diagnostic evaluation and treatment would be desirable, both to achieve optimal efficacy and to meet the diverse needs of women who suffer from this condition.
Critical Appraisal
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Insights
Acupuncture may be considered in patients with persistent, idiopathic vulvar pruritus.
Vulvar pruritus is a complex symptom of multifactorial origin, frequently affecting the patient’s quality of life. The treatment of patients with chronic pruritus (>6 weeks) is particularly challenging and often requires a multimodal strategy with an interdisciplinary approach. Besides the elimination of potential triggers and continuous lipid-replenishing basic care, antifungal agents and glucocorticoids are paramount. Medical professionals not specialized in the field should refer patients with refractory and/or suspicious lesions to an experienced gynecologist. A specimen should be obtained by punch biopsy for histological evaluation to rule out (pre-) malignant lesions.
It is central to the management of vulvar pruritus to offer a detailed discussion of the condition and treat patients with empathy. Their complaints should be taken seriously and patients should be informed about what could cause their symptoms and which treatment options are available for them.
