Vulval pruritus L29.20

Acute or chronic itching of the external female genitals with multifactorial, exogenous or endogenous origin. Vulval pruritus is a common symptom that often significantly reduces the quality of life of patients.

In Germany 17-23% of the population suffer from chronic itching. In 5-10% of cases the female genital, especially the vulva, is affected (Wölber L et al. 2020).

Causes of genital itching. The numbers in parentheses indicate the prevalences.

• Infections
  • candidiasis (10-20%)
  • Trichomoniasis
  • Pediculosis pubis
  • Genital herpes simplex
  • Tinea inguinalis
  • Scabies
  • Condylomata acuminata
  • Oxyuriasis

Underlying dermatological diseases with itching

• Chronic dermatitis (0.5-10%)
  • allergic contact dermatitis
  • Toxic contact dermatitis (often excessive cleanliness)
  • Atopic dermatitis (also as a minus variant)
• Lichen planus (0,1-0,8%)
• Intertrigo
• Psoriasis (intertriginous psoriasis, also occurring in isolation; prevalence about 2%)
• Pemphigoid bullous
• Pemphigus chronicus benignus familiaris (Hailey-Hailey)
• M. Fox-Fordyce
• Dyskeratosis follicularis (M. Darier)
• Lichen sclerosus et atrophicus (0.1-3%)
• Urticaria
• Kraurosis vulvae
• Leukoplakia
• VIN (exact prevalence is not available)
• Metabolic and endocrine disorders
  • Diabetes mellitus (see also Diabetes mellitus skin changes)
  • Kidney and liver diseases
  • Hyper/hypothyroidism (see also thyroid diseases skin changes)
  • Hypovitaminosis (esp. B6 deficiency)
  • Estrogen deficiency states (menopause)
• Other systemic diseases
  • Iron deficiency anemia
  • Polycythemia vera
  • M. Hogkin
• Psychological factors:
  • Psychogenic factors (defensive or desirable symptom).
  • Pruritus vulvae is not infrequently a sign of somatoform disorder.
• Other:
  • Pruritus during involution processes (so-called senile pruritus)
  • Anal fissures
  • Fistulas
  • Inflammatory bowel diseases

The clinical picture is different due to the multifactorial genesis. A systematic anamnesis with the following parameters is required:

• Duration of symptoms (acute/chronic) Note: chronic= duration of >6 weeks)
• Localization (local/generalized)
• Intensity (scale 0-10)
• Existing systemic diseases (e.g. diabetes mellitus; atopic diathesis; autoimmune diseases)
• Soothing or aggravating modulators
• Hormonal situation (pre-/postmenopausal?)
• Pre-therapies (local pre-therapies/systemic pre-therapies e.g. ovulation inhibitors)

In the case of therapy-resistant candidosis/infection, microbiological smears, culture-based detection methods and amplification techniques may be necessary to confirm the diagnosis. For a more precise assessment, a vulvoscopy with 7-30x magnification is recommended. Suspicious areas can be visualized more clearly by applying 5% acetic acid. With V.a. VIN a lesional 4mm punch biopsy is mandatory.

1. Wölber L et al. (2020) Pruritus vulvae - causes, diagnostics and therapy. Dtsch Ärztebl Int 117: 126-133