Vulval Dermatitis, Eczema and Lichen Simplex Chronicus

These often chronic, skin conditions are associated with itch, stinging, burning or even pain. They probably make up somewhere between a third and a half of all vulval skin disorders.

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What causes vulval dermatitis, eczema and lichen simplex chronicus? What does this condition look like? How is this condition managed?

What causes vulval dermatitis, eczema and lichen simplex chronicus?

These conditions are often caused by coming in contact with an agent that irritates or causes an allergic reaction in the skin – contact dermatitis.

Agents include over-washing, use of soaps, deodorants, or panty-liners etc.

Alternatively to contact dermatitis is a condition called atopic dermatitis or eczema. This relates to the reaction to unknown agents that cause an inflammatory reaction in the skin. The rash is often present on other areas of the body as well. It is important to exclude any irritants as mentioned above, as the cause.

What does this condition look like?

In acute cases the skin shows mild to severe redness with some scales in dry areas.

When the condition is more chronic the skin of the vulva may be generally swollen and excoriated from scratching as well as areas of thickening called lichenification (lichen simplex chronicus). In extreme cases there may be areas of cracking or splitting or even ulceration.

The symptoms are often made worse by having a period as blood and the use of pads further irritates the skin.

Secondary fungal (monilia) infections or bacterial infections are possible and need to be treated.

How is this condition managed?

It is important you treat your damaged vulval skin gently. Any infection needs to be treated. Use 500ml tubs of plain aqueous cream only as soap.

Avoid excessive washing or use of irritants such as perfumes, soaps or deodorants.

Seal the skin, especially at period time, with petroleum jelly, or use the jelly as a soothing agent. Antihistamines can be taken orally to help the itch.

Anti-inflammatory corticosteroid ointments should be used twice a day and be applied liberally to the skin. The strength of the ointment depends on the severity of the eczema or dermatitis. You do not need to apply the ointment to the vaginal skin.

It is important that Dr Kliman reviews your skin after a period of treatment to ensure improvement. If there is little improvement stronger corticosteroid ointment may be necessary. Treatment should always be tapered off.

Occasionally, if the diagnosis is unclear or if there is a question of precancerous skin changes a vulvoscopy will be performed. This is where the skin is illuminated with a microscope and possibly a biopsy will be taken under local anaesthetic.