Because vulvar pruritus has multiple etiologies, treatment depends on correct diagnosis.
- Lichen sclerosis. This condition is characterized by white patches that are extremely itchy and can develop into painful erosions and ulcerations. If left untreated, lichen sclerosis can scar the vulva, narrowing the vaginal opening. Extensive scarring can prevent intercourse and may close the urethra, causing women to have trouble urinating. Fortunately, if treatment begins before anatomic distortion occurs, response is excellent. Close monitoring is recommended, since recurrence is common and these women are at increased risk of developing vulvar carcinomas (cancer).
- Lichen simplex chronicus. This condition is caused by chronic exposure to irritants, leading to excessive scratching, which further traumatizes and irritates skin. Treatment is focused on eliminating potential irritants and preventing scratching. Women with this condition are instructed to wear gloves to bed, and a sleeping medication may be given to reduce scratching at night. These women are told to wash the vulva with water only, wear white cotton underwear, use white toilet paper, and to wash clothes with certain laundry detergents without fabric softeners. If they have an allergy to menstrual pads, a source for organic cotton pads is provided.
- Hidradenitis suppurativa. This condition causes acne-like lesions to grow into the skin, resulting in chronic inflammation. Women with this disorder experience various degrees of pain, drainage, and scarring. It is more common in overweight women, African-Americans, and women with a family history of the condition. Treatment begins with an antibiotic wash, hormonal intervention, and weight loss. Advanced disease requires aggressive surgical management.