Vulval itch.
BACKGROUND
Vulval itch is common. Patients presenting with this symptom can have a long history involving visits to several general practitioners. Self diagnosis as thrush is common, and inappropriate use of over-the-counter antifungal preparations can lead to further irritation and distress. Excoriation, rubbing, maceration, secondary infection and the effects of topical applications frequently complicate matters.


OBJECTIVE
This article identifies the common causes of vulval itch in adults and children, and highlights key features of the diagnosis and management of these conditions. Vulval pain syndromes are beyond the scope of this article and are therefore not discussed.


CONCLUSIONS
The cause of vulval itch can often be multifactorial, but with careful assessment, a primary diagnosis can be reached in most cases. A good history requires patience, and gentle direct questioning, as patients often feel uncomfortable discussing their problems and may not disclose self applied remedies. Care should be taken during examination, as vulval rashes may be subtle. All postpubertal patients should have a low vaginal swab to diagnose candidiasis rather than treating empirically.
Welsh
Belinda
B
St Vincent's Hospital, Melbourne, Skin and Cancer Foundation, Carlton, Dermatology/Vulval Conditions Clinic, Mercy Hospital for Women, East Melbourne. bwrk@optusnet.com.au
Howard
Anne
A
Cook
Kathy
K
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002181:Candidiasis, Vulvovaginal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D003872:Dermatitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D005194:Family Practice / Q000379:methods*; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D011539:Pruritus Vulvae / Q000209:etiology* / Q000628:therapy*; D011565:Psoriasis / Q000150:complications / Q000175:diagnosis / Q000628:therapy
D000935:Antifungal Agents