Itching or Burning?

In an earlier blog post, Dr. Susan Kellogg Spadt, PhD, CRNP, a MiddlesexMD advisor, referred to vulvar discomfort that may be caused by contact dermatitis. Because this is a common condition, I asked her to come back to the topic in more detail, describing two types—irritant contact and allergic contact dermatitis—what causes them, and how they can be treated.

Irritant contact dermatitis is characterized by a burning sensation. When the burning occurs after contact with the irritant, it’s a sign that the top layer of skin has been “compromised” or broken (part of the job of our layers of skin is to keep harmful things out). Common vulvar irritants include propylene glycol (an ingredient in many creams and lotions), abrasive toilet paper, oxylate from urine, soaps, detergents, shampoos, powders, conditioners, baby wipes, panty liners and their adhesives, chemically treated clothing, spermicides, lubricants, alcohol, douches, and deodorants.

To address this type of irritation, first figure out and eliminate the irritant—whether it’s bath soap, topical creams, or powdered detergent residue in laundered clothing. Minimize contact with urine by using a spray bottle of water on the genitals during and after urination. Twice-daily application of a hypoallergenic emollient or skin moisturizer, or a “natural” product like vegetable shortening or mineral oil, can help to heal the skin and prevent irritation from recurring.

Allergic contact dermatitis (also called atopic dermatitis or eczema) is a highly prevalent vulvar disorder characterized by persistent itching. This form of dermatitis results from—here’s some medical talk—a locally dysfunctional cell-mediated immune response that inhibits natural skin microbicides, allowing for higher than normal colonization of yeast and bacteria. As a result of environmental and genetic factors, as many as 40 percent of adult women have a history of this type of vulvar dermatitis; most women are at risk of developing it at some time during their adult life. Women with a history of asthma, hay fever, chronic sinusitis, yeast infections, or eczema on other body parts are particularly at risk.

Recognized allergens or allergic triggers include a dry climate, exposure to latex, elastic, fragrances, fabric softeners, benzocaine, neomycin, chlorhexidine (found in KY Jelly and many other lubricants), and tea tree oil. Allergic dermatitis often involves flaking skin, because skin cell proliferation and exfoliation are stimulated.

Diagnosis of this type of dermatitis is most often based on history, but a biopsy can be done by a health care provider to confirm the diagnosis. After diagnosis, typical treatment is the use of topical low- to high-potency steroid ointments. It may take several weeks of treatment for a full layer of healthy skin to replace the irritated skin. We know the therapy is working when there’s a decline in itching (or “pruritus”) and incidence of yeast infection.

Contact dermatitis of the vulva is exceedingly common in women. These disorders are not life threatening, but can be very “quality of life threatening,” interfering with comfort during daily activities as well as with intimate relationships. Recognizing potential allergens and irritants and seeking care early from a knowledgeable health care provider are two important steps a woman can take to insure her vulvar health.

The bottom line? The less that comes into contact with your vulvar skin the better. And, if you even suspect you have an issue, the sooner you seek treatment, the better. I’ve seen women in my practice who’ve spent months in discomfort (assuming they had a “yeast infection”) when they didn’t need to.