What Is Vulvar Dermatitis?

Vulvar dermatitis is a common skin condition that affects the female genital region. Every year, a significant proportion of women present to their healthcare provider with pain, itch, and redness around their vulva. The term ‘vulva’ is used to describe the external genitalia and consists of the labia majora, labia minora, the mons pubis, clitoris, and urethra.¹ Dermatitis means inflamed or irritated skin that is often red, dry, and itchy, although it may also present with a painful or burning sensation.² It is important to remember that vulvar dermatitis is not infectious and is not transmitted from person to person.³  

Vulvar dermatitis occurs due to a number of different reasons and this article aims to give you a better understanding of what vulvar dermatitis is, how it may affect you, and what you can do about it.

Types of vulvar dermatitis

The two most common types of vulvar dermatitis are contact dermatitis and atopic dermatitis, which is also known as eczema.⁴ Both of these conditions present in a similar way, so it is important to discover the underlying cause of your vulvar dermatitis in order to determine the best treatment for you. 

Vulvar dermatitis can be acute or chronic. Acute dermatitis can be severe and very painful, causing significant distress. Chronic dermatitis often presents milder with some redness and irritation. However, over time, it can progress and result in dry, scaly patches on the skin called plaques. There is also the risk of a secondary infection of the skin developing.⁵

Contact dermatitis

There are two types of contact dermatitis: irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). 

Irritant contact dermatitis

ICD is the most common form of contact dermatitis around the vulva. It occurs when a product comes into direct contact with your skin and causes damage to your skin cells. You do not need to have come into contact with the irritant before to have a reaction.⁵ The severity of the reaction will depend on the strength of the irritant and the duration of the exposure, which often results in pain or a burning sensation. Your skin may react suddenly or gradually worsen over a period of time as you reuse the irritant.⁶  

Allergic contact dermatitis

ACD presents similarly to irritant contact dermatitis but is caused by an allergen. It is a type IV delayed allergic reaction involving the skin, and it may take 48-72 hours to develop symptoms after exposure. This can make it difficult to identify the offending agent.5 Initially, symptoms usually include redness and itching in the area, but small blisters can also be present, which may cause weeping.

Atopic dermatitis

Atopic dermatitis is also called eczema. For those predisposed to developing eczema, the vulvar region for women can be a common area where it develops. Certain occasions, such as menopause, can make atopic dermatitis around the vulvar more likely.⁴ 

Other conditions that present similarly 

There are other conditions that may also present with painful, red, inflamed or itchy skin around the vulvar. It is important that your healthcare provider rules out other causes before starting you on treatment. Below is a list of other potential conditions which present similarly to vulvar dermatitis.⁴

• Lichen planus
• Psoriasis
• Infectious causes such as fungal or bacterial infections
• Seborrheic dermatitis
• Vulvar cancer
• Vaginitis (swelling of the vagina)
• Vaginal atrophy (inflammation of the vagina)

Common causes and risk factors

Irritants and allergens

Many different substances can aggravate the skin around your vulva. Some of the most common irritants and allergens include.⁵

• Urine, faeces, and other bodily fluids
• Feminine hygiene products such as wipes, tampons, sanitary towels, toilet paper
• Soaps, bubble baths, shampoos and fragrances
• Condoms, lubricants, and spermicides
• Laundry detergents and fabric softeners
• Topical medicines (such as antibiotics, anti-itch creams, antifungals, tea tree oil, alcohol-based creams, and other creams.)
• Physical irritants such as tight clothing, nylon, latex, and excessive washing
• Metals - eg. nickel

Other contributing factors

Other factors can also contribute to the development of vulva dermatitis, such as a genetic predisposition to eczema, lifestyle factors such as emotional stress, frequently wearing tight clothing or excessive sweating. 

Hormones can also play a role; menopause causes a reduction in the hormone oestrogen, which results in dryer, thinner skin around your vulva, making it more susceptible to irritation or injury.4 You are also more likely to develop vulva dermatitis if you suffer from faecal or urinary incontinence, as these can collect on the skin, leading to irritation.

Signs and symptoms

These will vary depending on the cause of your vulva dermatitis and the severity of the reaction. You may also find that the severity of your symptoms fluctuates, worsening at night, during intercourse, when you’re on your period, or when you’re excessively sweating. Common symptoms include:^4,7

• Itching (Pruritus)
• Redness and swelling
• Dry skin
• A burning sensation (more common with irritant contact dermatitis)
• Pain or discomfort 
• Changes in skin texture, such as the formation of plaques on the skin (associated with atopic vulvar dermatitis)
• Discharge or weeping from the affected area
• Possible complications, such as the development of a secondary skin infection 

Diagnosis

If you feel like you may present with any of these symptoms, it is important to seek guidance from your healthcare provider, who can diagnose whether you may have vulvar dermatitis. They may diagnose you through:^4,7 

1. Medical history - your healthcare provider will take a full medical history, including a history of any previous skin conditions, allergies, medications you take, and family history. They will also ask you about the severity of your symptoms and if anything makes it better or worse. You will discuss your lifestyle, including details about your vulva care and what creams and products you use. It may be helpful to write a list of these to take with you to your appointment.
2. Physical examination - after discussing your medical history, your healthcare provider will examine your vulva and vagina. They will be looking for signs of inflammation, irritation, and infection. They may take a swab of your vaginal discharge to rule out any yeast or bacterial infections as a cause. 
3. Allergy testing - if your provider suspects that your symptoms are due to allergic contact vulvar dermatitis, they may want to do a patch test. This will involve testing a small amount of a potential allergen on your skin and monitoring the reaction.
4. Skin Biopsy - a skin biopsy may be performed if your provider is unsure of the diagnosis based on examination and history or if the treatment is not working. Skin biopsies can also be used to rule out rarer conditions such as vulvar cancer.

Treatment

Once your doctor has diagnosed that you have vulvar dermatitis, there are a number of different treatment options that they may recommend.

Avoiding triggers and irritants

If the cause of your vulvar dermatitis is due to contact dermatitis, your doctor will advise you to avoid any potential irritants or allergens. If the exact cause is not obvious, then you may be placed on a ‘skin diet’ where you avoid using any topicals except for a couple of hypoallergenic products before you gradually reintroduce other products.⁷

Lifestyle changes

You will be encouraged to practice good vulvar care; this means keeping the vulvar area dry and clean. You should use only warm water and mild unscented soap to clean your vulvar once a day maximum and then pat dry with a clean towel. Other good practices include only wearing 100% cotton underwear, rinsing underwear after washing, using hypoallergenic, unscented laundry detergents, and wearing loose-fitting clothing.^4,8 

When it comes to vulvar care, it is important to remember that the fewer products that come into contact with your vulvar and the less you touch it, the less likely it will become irritated.⁴

Medications

If your healthcare provider determines that you suffer from contact vulvar dermatitis, then the discontinuation of the allergen or irritant that triggers it should be enough to resolve your symptoms and prevent them from re-occurring. However, whilst you’re waiting for your skin to heal, you may be prescribed topical or oral medication to manage the symptoms and speed up the healing process. Some examples of medications that may be prescribed:^4,7

• Oral antihistamines - to stop you from scratching the area, particularly in your sleep.
• Topical steroid creams - hydrocortisone, which reduces inflammation of the skin.
• Topical emollients (moisturisers) may be prescribed to help with dry skin, which is particularly common if you have atopic vulvar dermatitis (eczema)

Antifungal or antibacterial medications

If your healthcare provider thinks that your symptoms are either due to a fungal or bacterial infection or there is a concurrent infection alongside your vulvar dermatitis, you may be prescribed a topical anti-fungal or anti-bacterial medication to treat this.

Preventing vulvar dermatitis

Once your vulvar dermatitis has been successfully treated, it is important that you take measures to prevent a re-occurrence.  

Most importantly, avoid known triggers and try not to use new products such as soaps, creams, or laundry detergents. Practice good vulvar care by keeping the area clean and dry and remembering that when it comes to the sensitive skin around your vulvar, the fewer products and materials that come into contact with it, the better.⁸ If you have known atopic dermatitis (eczema), then ensure the skin is well moisturised with an unscented emollient.

Lastly, make sure you seek medical advice if you feel your symptoms are worsening or not improving with treatment. 

Prognosis

The type of vulvar dermatitis you have will determine how long it takes for you to recover. Chronic dermatitis may take a couple of weeks to resolve or longer if there is a concurrent skin infection.⁴

You may not always be able to prevent a flare-up of vulvar dermatitis, but it can be easily treated with topical steroids and antihistamines, so it is important to reach out to your healthcare provider as soon as you develop symptoms. 

If you suffer from atopic vulvar dermatitis (eczema), then stress can also play a role in flare-ups or worsen ongoing symptoms. Being aware of your stress levels and having healthy coping strategies in place can help you mitigate this.

Summary

Vulvar dermatitis is caused by irritants, allergens or eczema. Common symptoms include redness, itching or dry skin. Ensure you practice good vulvar care and try to avoid possible irritants and allergens.  It is important to seek medical guidance from your healthcare provider to help you guide your treatment plan. The medication prescribed by your doctor aims to help relieve your symptoms so you can have an overall better quality of life.