CONTACT DERMATITIS OF THE VULVA
CONTACT DERMATITIS OF THE VULVA
What is contact dermatitis? Contact dermatitis is a rash that results when the skin reacts to a substance that is applied to it. This can either be a burn or an allergic reaction. Examples of things that can cause this are creams, ointments, gels, sprays, sanitary pads, dyes or clothing. The rash may occur suddenly with blisters, itching and weeping (like a reaction to poison ivy) or it may be of slower onset with redness, burning and some swelling. Contact dermatitis of the vulva can occur alone or it can complicate any other vulvar skin condition like a yeast infection, psoriasis, lichen sclerosus, or eczema.
Where does it occur?
Any part of the vulva or perineum may be involved, from the mons pubis to the anus, even out onto the inner parts of the thighs. The extent of the rash will depend on where the offending product has touched the skin and how sensitive you are.
What are the different types of contact dermatitis?
There are two types.
1. Irritant contact dermatitis – this is the most common cause of vulvar contact dermatitis. It is a reaction to a caustic or irritating product that injures the skin. For instance a strong chemical burn from trichloroacetic acid used to “burn off” warts would cause an irritant contact dermatitis. Repeated exposure to mildly irritating products like soaps or gels can eventually burn the skin causing an irritated contact dermatitis. Urine and vaginal secretions touching the skin can also cause a similar problem. One of the most common causes of an irritant vulvar rash is cleansing too often or using too strong a cleanser or soap.
2. Allergic contact dermatitis – this is a reaction on the skin that develops due to your body’s allergic response to a substance, like poison ivy, applied to the skin surface. Possible causes of such a reaction in the vulvar area are benzocaine (found in local anesthetic creams), neomycin (antibiotic creams), preservatives (in toilet wipes, emollients and prescribed steroid creams or ointments) or perfumes (widely used in many hygiene products). Like irritant contact dermatitis, these reactions may be mild with just minor redness, swelling and itching or severe with blistering, bright red swelling and severe discomfort.
What does it look like? What does it feel like?
There is a “rash” seen on the vulva. One can feel a varying degree of itching, burning and irritation that can be mild to severe depending on one’s reaction. The discomfort can start very slowly and build up with repeated use of the offending product or it can be very sudden in onset with a severe reaction to a product that is very irritating or to which you have a strong allergic response. In the severe reactions there can be blistering and open weeping, tender red areas and sometimes bleeding. More often there is redness with swelling and
sometimes crusting. With scratching the crusting can be worse.
How is it diagnosed?
Diagnosis is based on the history of exposure to the offending substance and the pattern of the rash. The diagnosis is made by your health care provider on the basis of the above factors. If the reaction is due to an allergy then special patch testing is done with a number of chemicals and placed on your back for 3 days to determine what is causing the reaction. This can be done by a dermatologist or an allergist.
How is it treated?
The offending chemical must be stopped. A cortisone/steroid ointment applied to the area is usually used twice a day for one to two weeks. If the reaction is very severe, oral cortisone may be used.
What can I do myself?
Be sure to stop any possible irritating factors. Stop using all soap because excessive soap and water strip away the skin’s protective cover. When washing, just use plain water or plain water with a soap substitute with your hands only and gently rinse the area, then pat dry. To protect the skin use plain petrolatum or a zinc oxide ointment. If there is weeping and considerable discomfort, stop any cream or ointments until you sort out what the cause of your problem is. Use only cotton menstrual pads or tampons.
Common vulvar irritants include:
- Soaps and cleansers
- Panty liners and menstrual pads
Vulvar allergens (those causing an allergic response) include:
- Preservatives (some moist toilet wipes)
- Benzocaine (Vagisil)
- Neomycin (Neosporin)
- Chlorhexidine (KY)
- Nail Polish
- Latex Condoms
For further information on the Internet:
For written medical information:
Margesson LJ. Contact dermatitis of the vulva. Dermatologic Therapy
International Society for the Study of Vulvovaginal Disease
Patient Information Committee