Pruritus vulvae

Gopal, Gomathy; Hadoura, Essam; Mahmood, Tahir

doi:10.1016/j.ogrm.2016.01.001

Cited by 1 publication

(1 citation statement)

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“…DG-VS is an identifiable and treatable cause of vulvar symptoms. Still, the literature on vulvar health scarcely includes DG-VS in the differential diagnosis ( Byth, 1998 ; Gopal et al, 2016 ; Sand and Thomsen, 2018 ). Notably, DG-VS is not included in dermatologic, gynecologic, and sexual health guidelines or reviews of vulvar pain ( Bornstein et al, 2019 , 2016 ; Committee on Practice Bulletins - Gynecology, 2020 ; Lynch et al, 2012 ; Mauskar et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Dermatographism with vulvar symptoms

Rivera

Mirowski

2021

International Journal of Women's Dermatology

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Dermatographism (DG) is characterized by a localized, inducible, wheal-and-flare response along the distribution of mechanical pressure. We report an illustrative case of DG with vulvar symptoms (DG-VS) and review the literature on this rarely recognized but easily treated etiology of vulvar complaints. A 35-year-old woman presented with a 1-year history of vulvar pruritus unresponsive to antifungal, antibacterial, and steroid treatments. A prior punch biopsy was nondiagnostic. Vulvar examination revealed normal architecture and no cutaneous abnormalities. She was markedly dermatographic with a scratch test. DG-VS was diagnosed. The patient achieved complete symptomatic control on low-dose hydroxyzine. She maintains excellent control at 3.5 years. In the literature, a typical patient with DG-VS is of reproductive age, with several years’ history of vulvar symptoms (itching, burning, pain, or swelling) and repeated empiric treatment for infectious/inflammatory etiologies. Exacerbation with sexual activity, menstruation, or wearing tight clothing is characteristic and supports the role of mechanical pressure in inducing focal symptoms. Dermatologic changes to the vulvar skin are rarely noted. DG-VS is diagnosed based on clinical findings, symptom patterns, and a positive scratch test and is treated with antihistamines. DG-VS remains absent from current vulvar disease guidelines. In the complex world of vulvar pain and itch, an etiology so easily screened for and readily treated warrants consideration.

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