Diseases That Cause Vulvar Itching Lichen Simplex Chronicus

Lichen simplex chronicus (LSC) of the vulva is a dermatologic condition that causes pruritus. Women may have mild to intense itching, which can occur during the day or night. If the LSC is severe, a woman may commonly scratch

Figure 8 Lichen simplex: hyperkeratosis and erythema of the left labia majora. (See color insert pp. 4 and 5.)

the vulvar area in her sleep or be awakened by intense vulvar itching. Many times, a partner identifies that the woman is scratching without awakening.

The etiology of LSC of the vulva tends to be mechanical in nature. Whenever there is irritation that occurs long enough for the itch-scratch cycle to develop, the epidermis and stratum corneum of the vulva thicken (15). The skin of the vulva appears lichenified, with or without the presence of excoriations. The vulvar skin can appear white and crinkled, red, or even take on a violaceous hue. The skin changes are localized to the area of the itch (Figs. 8 and 9).

Treatment for LSC requires breaking the itch-scratch cycle. Topical low-to-moderate-potency steroid ointments are helpful. Occasionally, in severe cases, a high-potency steroid may be required. For women who are scratching during their sleep, the short-term use of amitriptyline 10 to 25 mg at bedtime will help the patient sleep through the itch sensation. It is also important for the patient to adhere to vulvar skin hygiene guidelines, as well as to use a daily skin protectant. A low-talc powder to help control moisture and perspiration is helpful. Zinc oxide ointment provides an effective moisture barrier that also has a slight drying effect, which is especially useful in warm climates. Lukewarm water with baking soda or colloidal oatmeal also provides symptomatic relief. If the skin is severely lichenified and macerated, an aluminum acetate 1:40 solution soak or compress (Domeboro Astringent Solution, Bayer, Morristown, NJ, U.S.A.) can assist with comfort and healing.

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