Contact Dermatitis of the Vulva

Contact dermatitis of the vulva is an inflammatory condition that can occur at any time during a woman's life in response to primary exposure to an irritant or from an allergic response to an irritant. Contact dermatitis also can occur secondary to another condition, such as a vaginal yeast infection or urinary and/or fecal incontinence. Common causes of irritative contact dermatitis of the vulva include laundry detergent, fabric softeners, body soaps, perfumes, hygienic wipes, and douches. In addition, many over-the-counter topical treatments as well as medications that have alcohol in the base, such as creams, can be chemical irritants. Typically, a patient describes vulvar/vaginal burning that is at its lowest intensity upon awakening in the morning but increases as the day goes on. Symptoms can be aggravated during and after urination and by touching or wiping the area. There may be an associated discharge, which is from "weeping" of the vulvar tissue rather than discharge from the vagina.

On examination, the vulvar vaginal area has uniform, symmetrical, and well-demarcated erythema, with or without edema (Figs. 2-4). Treatment for contact dermatitis of the vulva requires that the patient follow strict vulvar hygiene guidelines. This includes removing all contact irritants and exposure to chemicals such as laundry products and personal hygiene products. It is also important to decrease friction to the vulvar skin by avoiding

Healing Vaginal Contact Dermatitis
Figure 2 Contact dermatitis: uniform, well-demarcated erythema of the labia majora and labia minora. (See color insert pp. 4 and 5.)

tight-fitting/restrictive clothing. Also, decreasing moisture to the irritated area is helpful. Patients should avoid wearing synthetic fabric clothing and wear cotton undergarments to help promote air circulation and, thus, decrease the effects of perspiration and moisture on the vulvar skin. Normal vaginal discharge,

Swollen Vaginal Labia
Figure 3 Contact dermatitis: uniform erythema and edema of the labia minora and intro-itus (same patient as in Fig. 2). (See color insert pp. 4 and 5.)
Vulvar Dermatitis Disease
Figure 4 Same patient as Fig. 3 showing contact dermatitis: vulva is shaved, erythema is present in uniform distribution from daily pad wear. (See color insert pp. 4 and 5.)

menstrual flow, and normal urine also irritate the affected vulvar tissues; therefore, a bland occlusive dressing helps provide a moisture barrier to protect irritated vulvar skin. Products such as zinc oxide ointment, vegetable oil, or olive oil have proven to be useful for this purpose. A + D ointment can also be useful, but care needs to be taken with the use of this product as it contains lanolin, which can be a potent skin sensitizer for some patients.

The application of a low-to-moderate potency topical steroid ointment can hasten the resolution of the symptoms of contact dermatitis of the vulva. However, the patient must be cautioned that using steroids on the genital tissue can cause steroid atrophy. In addition, of lukewarm water soaks with either baking soda or colloidal oatmeal is useful to decrease inflammation and provide symptom relief.

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