Picor vaginal: 4 formas de tratarlo
It can lead to serious impairment of quality of life, impacting sexual function, relationships, sleep and self-esteem. In this review, common conditions associated with vulvar itch are discussed including atopic and contact dermatitis, lichen sclerosus, psoriasis and infectious vulvovaginitis.
We review the potential physiologic, environmental and infectious factors that contribute to the development of vulvar itch and emphasize the importance of addressing their complex interplay when managing this disruptive and challenging symptom. Introduction Vulvar pruritus is a frequently chronic and debilitating symptom associated with many vulvar disorders. The exact prevalence of vulvar pruritus is unknown as epidemiologic data are aliviar picor vulva and most reports focus on individual conditions involving genital itch.
In a study that surveyed women from the general population in Boston, Massachusetts, 6. The true prevalence of vulvar pruritus may be difficult to assess as it is likely underreported given the embarrassment many women feel when discussing genital symptoms 3. Similarly, in a survey study performed in the United Kingdom, Vulvar pruritus can have a profound impact on quality of life 6.
In patients with genital psoriasis, itch was reported to be the most bothersome symptom with substantial impact on sexual relationships and psychosocial well-being 7. Moreover, several studies have demonstrated the negative impact of lichen sclerosus, a condition characterized by genital itch and pain, on sexual satisfaction 8 — Pruritic Vulvar Dermatoses Vulvar pruritus arises in the setting of many inflammatory, infectious, and neoplastic processes that can affect the female genitalia Inflammatory Common Etiologies Common inflammatory vulvar dermatoses characterized by marked pruritus include atopic and contact dermatitis, lichen planus, lichen simplex chronicus, psoriasis and lichen sclerosus, among others.
In a separate prospective cohort study, Similarly, AD and ICD have been reported to be the most common cause of vulvar symptoms in prepubertal girls AD is a genetic skin disease characterized by an altered skin barrier and chronic pruritus.
It presents acutely as erythematous edematous or vesiculated plaques. Lichenification and dyspigmentation may be observed in chronic cases. It is important to note that due to the altered skin barrier, patients with AD may be at higher risk for the development of both irritant and allergic contact dermatoses 16 — Contact dermatitis consists of inflammation of the skin resulting from an external agent that acts as an irritant or as an allergen.
The manifestation of both forms of dermatitis is very similar, varying from mild erythema and scaling to more severe erythema and edema The area of involvement may be localized to the exposed site or be more extensive as the product spreads, with moisture or scratching In addition to itch, pain and burning may also be present.
Ulceration and erosions may be seen with primary irritants In ACD, vesiculation in the acute phase may be observed In more chronic cases, lichenification with excoriation are common features.
Many substances can cause irritation of the vulva, including body fluids, feminine hygiene products or various topical medications Physical and thermal irritants like tight fitting clothes, wash cloths, sponges and hair dryers have been implicated in ICD development 20 Similarly, allergens often contribute to itch and dermatitis in patients with vulvar disease.
Common allergens include fragrances and preservatives in products like soaps and detergents, cleansing wipes, antiseptics, spermicides, sanitary pads, lubricants, and even topical treatments like steroids, anesthetics, antibacterial and antifungal agents 20 Rubber products, like pessaries, condoms, diaphragms, and gloves may also be sensitizers Additionally, pantyhose and clothing with azo dyes may contribute to ACD Patch testing may identify the allergens responsible for ACD.
Lichen simplex chronicus LSCor circumscribed neurodermatitis, is an eczematous disorder that commonly affects vulvar skin. It presents as scaly, thickened plaques that develop in response to persistent and vigorous scratching of intensely pruritic sites Although often considered a primary diagnosis, LSC often arises as a secondary finding in the setting of neuropathic or other underlying primary cutaneous diseases such as AD, ACD or LP It can also occur in patients with psychiatric disorders like depression and obsessive-compulsive disorder 27 Pruritus in systemic diseases such as end stage renal disease, obstructive biliary disease or Hodgkin’s lymphoma can also provoke LSC LSC is characterized by a self-perpetuating itch-scratch cycle.
In patients with primary LSC, the itch-scratch cycle is often triggered by initial skin irritation from tight-fitting clothing, irritating fabrics or personal care items which provoke scratching 11 Damage to the vulvar epithelium due to scratching compromises the skin barrier, potentially provoking release of epithelial cytokines and making the skin more vulnerable to potential infection, which in turn drives itch and inflammation If sufficiently pronounced, scratching results in hypertrophy and lichenification of the genital skin.
Clinical examination usually reveals lichenified plaques with excoriations and variable levels of erythema and scale Psoriasis is another common inflammatory skin disease that affects genital skin and is often accompanied by pruritus Psoriatic lesions of the vulva are more common in children than in adults.
Clinical features of vulvar psoriasis consist of well-demarcated, brightly erythematous plaques with or without scale on the labia majora Plaques may extend to the inguinal folds and maceration may be present Lichen sclerosus LS is another inflammatory dermatosis that affects the vulvar and vaginal mucosa, and not uncommonly extends to the perineum and perianal skin.
While vulvar LS can occur at any age, most cases are observed in prepubertal girls or in postmenopausal women, when endogenous estrogen production is low Pruritus and pain are predominant symptoms of the disease, although rarely LS may be asymptomatic. Other symptoms include dyspareunia and dysuria.
In children, constipation may be a presenting symptom due to pain with defecation The exact prevalence of LS is unknown, but estimates range from toof all adult patients referred to dermatology departments The estimated prevalence in prepubertal girls is 1 in At a general gynecology practice, the rate of vulvar LS was estimated to be 1.
Again, the discrepancy in reported prevalence among gynecology and dermatology practices may reflect the hesitance of patients to discuss genital symptoms outside of a dedicated health visit focused on genitourinary care. LS typically manifests as atrophic, pale to white patches or plaques that often form a figure-of-eight pattern encompassing the vulva and anus Erosions and painful fissures may be observed due to underlying inflammation as well as scratching or irritation of the inflamed, fragile tissue.
Loss of normal vulvar architecture may be observed in more advanced cases, with burying of the clitoris and agglutination of the labia. Lichen sclerosus is associated with increased risk of developing genital squamous cell carcinoma SCC. In a more recent study that used data from the Dutch Pathology Registry and included 3, women diagnosed with lichen sclerosus, the risk of SCC development after 10 and 20 years was 3. Lichen planus LP is a highy pruritic, autoimmune mucocutaneous disorder in which activated T-cells target basal keratinocytes of keratinized and non-keratinized squamous epithelium LP predominately affects adult women, although isolated cases have been reported in young girls Vulvovaginal LP may manifest in several ways, presenting in erosive, papulosquamous, and hypertrophic forms Erosive LP, the most common presentation affecting genital skin, is characterized by well-demarcated glassy, erythematous to violaceous patches with a hyperkeratotic border and primarily affects the non-keratinized epithelium of the vestibule, labia minora and vagina Several cohort studies have examined the distribution of LP subtypes arising on keratinized skin of the labia majora 48 Similar to LS, longstanding and untreated disease may lead to alterations in the normal architecture with narrowing of the aliviar picor vulva introitus Other Etiologies Inflammatory vulvar pruritus may also be caused by seborrheic dermatitis, plasma cell vulvitis, and Fox-Fordyce disease.
Seborrheic dermatitis is an inflammatory condition that affects the sebum-rich areas of the body and should be considered in patients with vulvar pruritus. While uncommon, seborrheic dermatitis can occasionally present on the vulva, and is usually associated with simultaneous appearance of characteristic seborrhea on the scalp and face It manifests on the vulva as erythematous plaques mainly on the labia, majora, perineum, and mons pubis.
Scale is frequently absent in the vulva and the severity of pruritus is often more marked than would be expected based on the clinical signs Plasma cell vulvitis PCV is an extremely rare cause of vulvar pruritus characterized by a well-circumscribed erythematous plaque composed of predominately plasma cells 53 It is typically located within the vulvar vestibule, often extending to the medial labia minora.
The most common symptoms associated with PCV are pruritus, pain, burning, and dyspareunia Fox-Fordyce disease is another rare inflammatory condition which can affect vulvar skin and may provoke intense itching. The primary pathophysiologic process involves obstruction of the apocrine sweat duct and subsequent ductal rupture causing inflammation and enlargement of the glands The mons pubis and labia majora are most commonly affected.
Clinically, Fox-Fordyce disease manifests as intensely pruritic, numerous, flesh-colored to slightly yellow papules 57 Infectious Common Etiologies Vulvar pruritus may be associated with several types of infections and these vary with age.
In prepubertal females, infection with Group A beta-hemolytic streptococcus GABHS commonly provokes vulvar symptoms including pruritus and pain, and manifests with sharply demarcated, edematous, red plaques Increased estrogen levels, which have been implicated in reducing the inhibitory activity of epithelial cells against Candida, are thought to account for the rise in candidiasis in women of reproductive age Pregnancy, antibiotics, oral contraceptives and hormonal replacement therapies may increase estrogen levels resulting in an increased frequency of disease 66 Tamoxifen, an estrogen antagonist in breast tissue, has been reported to have estrogen-like effects on vaginal epithelium in postmenopausal women, increasing risk of vulvovaginal candidiasis 68 — In addition, compromised immune function is also associated with increased risk of yeast infections, as has been observed in patients with diabetes, HIV or who regularly use systemic or topical corticosteroids Patients with recurrent candidal vulvovaginitis, defined as the occurrence of at least four episodes in 1 year, may have a predisposing genetic factor underlying their susceptibility Clinical presentation of vulvar erythema, pustules or erosions and vaginal discharge may vary, but symptoms of pruritus and burning are commonly observed.
Additional symptoms may include dysuria and dyspareunia. Identification of the specific Candida species can be considered in patients with refractory or recurrent vulvovaginal candidiasis as some species are often resistant to treatment Other Etiologies In contrast to GABHS, which commonly affects prepubertal females, Staphylococcus aureus, Haemophilus and Shigella infections are less common infectious causes of vulvovaginal pruritus Enterobius vermiuclaris pinworm infestation may be another source of vulvar and perineal pruritus in younger females worldwide In adults, the two most common parasitic vulvar infestations are pediculosis pubis pubic lice and scabies Both cutaneous infections are often seen in young adults and are typically acquired during sexual contacts.
Vulvar pruritus is the predominant symptom that develops following allergic sensitization 52 In pediculosis pubis, adult lice and their eggs nits can be visible to the naked eye. Infection may spread from the genital area to other parts of the body, such as the thighs or trunk Infestation with scabies causes widespread itching with nocturnal predominance. Unlike in other areas of the body, burrows on the vulva are uncommon and may be masked by excoriations or secondary infection Tinea cruris is an additional infection that can cause vulvar pruritus in women 52 ,