Vulva Itching With all due respect to my gynecology colleagues, when faced with an itching groin, few of them offer the systematic approach this problem often needs. Most will assume the rash is due to Candida ( yeast) and treat the problem with an anti-fugal of some sort. If this fails, the gynecologist may resort to an corticosteroid. Very few will patch test their patients, or even offer a referral to the dermatologist for patch testing. Yet many of their patients will suffer with itching for quite some time before the source is figured out. In order to determine the extent of allergic contact dermatitis and the most frequent allergens, investigators employed patch testing to the standard series we dermatologists use and a gynecology series. Ninety women with itching, burning, pain or discharge in the vulvar area, and a suspicion of having a contact allergy were tested. The results, which were reported recently in Dermatitis, were both surprising and interesting. Of the ninety women tested, 62 had a positive patch test and of those, 35 of those positive tests were considered relevant ( half for those mathematically challenged). The most common positives in the standard series were fragrances, balsam of Peru ( fragrance), Benzocaine ( found in the popular Vagisil) and Quaternium 15 ( a common preservative). In the gynecologic tray, the most common allergens were Terconazole ( main active ingredient in Terazol 7), benzoic acid ( used by the way in nearly all preserved saline) and parabens ( another preservative). Less common relative positives were metals ( especially gold), topical antibiotics ( such as Neosporin and Bacitracin) and other anti-fungal agents. Older women were more likely to have positives. The most common diagnosis in women with a relevant positive patch test was lichen sclerosis. There are some unique features that make this area more prone to an allergic contact dermatitis. Vulvar skin is subject to increased heat, moisture, and chafing. The skin may also come in contact with paper products such as toilet paper, sanitary pads, tampons and, in the elderly incontinence pads). Many women will utilize over the counter products such as scents, talc, douches or shaving creams. I was surprised at the high percent of positives found in this study. This accents the fact that we should be performing patch tests more often when faced with an undiagnosed vulva itch. By the way, for those who do not know: in patch testing strips containing the allergen are placed on the skin of the back. They are pulled off in two days and re-examined in four days. The test is painless and obviously has the potential to give us many solutions.
Posted on: Mon, 10 Jun 2013 01:11:21 +0000
Trending Topics
Recently Viewed Topics
© 2015