Prospective study of patch testing in patients with vulval pruritus

Abstract

SUMMARYForty-three patients with the primary complaint of vulval pruritus were recruited to take part in this prospective patch-testing study. A detailed questionnaire was administered to each and patch testing to an extended battery of allergens was undertaken. This included the European standard series, preservatives, corticosteroids and a battery of common over-the-counter topical vulval treatments. Analysis of demographic data and prior treatments used, and various other parameters, were studied in the context of patch-test results. This prospective study reports a very high rate of contact sensitivity in patients presenting with vulval pruritus, with 81.4% of those tested having at least one contact allergen detected. One or more clinically relevant allergens were found in 44% of the subjects patch tested. The variables found to predict a greater likelihood of a contact allergy were a biopsy diagnosis of vulval dermatitis, the use of multiple topical treatments, sexual inactivity and patients with severe pruritus on a selfreported scale. Most importantly, many clinically relevant allergens these patients reacted to were outside the European standard series. This highlights the need for an extended series in this patient population.

Non‐Infective Cutaneous Conditions of the Vulva

“…Those with vulval lesions alone had positive relevant findings in 19%, those with perianal disease alone in 33%, but those in whom both areas were involved there were positive relevant findings in 43%. A recent prospective study of 43 patients with vulval pruritus showed 44% to have relevant patch test reactions (Haverhoek et al 2008). In all studies, the relevant positive reactions were mainly to medicaments, local anaesthetics, corticosteroids and scented products.…”

The Normal Vulva, Vulvar Examination, and Evaluation Tools

“…Studies report various results of positive reaction to patch testing, ranging from 16% to 78%. [34][35][36][37] This wide range is explained partially by different populations tested, either patients suffering from general vulvar pruritus, specific dermatoses or highly suspected of contact dermatitis, and whether the reaction measured was relevant to the clinical presentation. It is commonly agreed, that the rate of allergic and irritant contact dermatitis among patients suffering from vulvar symptoms is high, and it is not uncommon to find it complicating other established vulvar condition.…”

Pruritus in Female Patients

“…A prospective study showed a very high rate of contact sensitivity in patients presenting with vulval pruritus. One or more clinically relevant allergens were found in 44% of the subjects tested [5]. Many relevant allergens did not belong to the European standard series so there is a need for extended patch testing.…”