Vulvar Dermatitis Irritant Contact Dermatitis

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A survey of German family physicians, gynecologists, and dermatologists in 1998 revealed that 24% to 38% of patients with noninfectious genital complaints had a diagnosis of vulvar dermatitis, while the incidence was 20% to 30% in Oxford, U.K., in 2000 (2,18). There are three prototypic clinical responses to irritants: acute irritant dermatitis, chronic (cumulative) irritant dermatitis, and sensory irritation. The acute type develops as a result of exposure to a potent irritant and is equivalent to a chemical burn. The cumulative, chronic type results from repeated exposures to weak irritants and can be confused with allergic contact dermatitis (ACD). Sensory irritation is characterized by stinging and burning caused by chemical exposure with no detectable skin changes. All three types can affect the vulva, and some chemicals, such as propylene glycol, can cause irritation as well as sensitization (18,19). The antiviral medication acyclovir, imiquimod, and podophyllotoxin can cause acute to subacute irritant contact dermatitis (2). The more frequent chronic irritant contact dermatitis has both endogenous and exogenous causes. Some endogenous etiologies include obesity, which results in increased moisture accumulation; increased humidity, with resultant increased friction coefficient; and incontinence, with both moisture and ammonia irritants. Some exogenous vulvar irritants include clothing, soaps, spermicides (non-oxynol 9 and benzalkonium chloride), and antiseptic solutions (0.3% chlorhexidine) (2). Overzealous hygienic practices, using irritating soaps and antiseptic wipes, can often cause irritant contact dermatitis in the vulva, as well (18). Wigger-Alberti and Elsner describe 10 subtypes of irritation (20):

1.

Acute

2.

Acute delayed

3.

Irritant reaction

4.

Cumulative

5.

Traumiterative

6.

Exsiccation

7.

Traumatic

8.

Pustular and acneiform

9.

Nonerythematous

10.

Subjective

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