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Therapeutics in Dermatology
A reference textbook in dermatology

Vulvar Pruritus

5 June 2012, by DEHEN L.

Pruritus is an important sign in vulvar disease and, in most cases, is an indicator of an underlying disorder which must always be identified through a careful locoregional examination.

1 - DIAGNOSIS

The patient reports pruritus and an itching sensation leading to scratching. Careful questioning will help establish the time of onset. Recent, acute itching is suggestive of an infectious cause or a contact vulvitis. Chronic pruritus, whether permanent or intermittent, may be caused by a vulvar dermatosis, primarily lichen sclerosus or malignant disease. The pattern of the itching (cyclical or sporadic), its location (localised or diffuse) and the existence of other symptoms (discharge, burning, dryness, dyspareunia and bleeding) should also be determined. The clinical examination should be conducted under good lighting conditions with the patient in the lithotomy position, using a magnifying glass when necessary. Careful visual inspection is necessary, focusing initially on the skin of the labia, perineum, perianal region, gluteal fold, pubis and intergluteal fold and then on the mucosa, spreading the labia, the interlabial folds, the labia minora and the clitoral hood; the labia minora should then be parted again to expose the vestibule. It may sometimes be necessary to examine the vagina and cervix using a speculum. Examination of skin elsewhere on the body, the oral mucosa, scalp and nails may also provide additional information.

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