What can cause vulvar swelling and pain, possibly due to an allergic reaction, and what treatments, including topical steroids, can be applied to the vulvar area for management?

From the Guidelines

Vulvar swelling and pain can be caused by various factors, including allergic reactions, and topical steroids such as ultrapotent topical steroids can be applied to the vulvar area for management, as seen in the treatment of lichen sclerosus 1. For management:

• Apply a cool compress to reduce swelling and discomfort.
• Use over-the-counter hydrocortisone cream (1%) for temporary relief, applying a thin layer to the affected area up to 3-4 times daily for no more than 7 days.
• Take an oral antihistamine like cetirizine (10mg daily) or diphenhydramine (25-50mg every 4-6 hours) to reduce allergic symptoms, as suggested by the American Academy of Pediatrics for relieving inflammation of the skin in response to topical therapeutic agents 1.
• Avoid potential irritants such as scented soaps, douches, or tight clothing.
• If symptoms persist or worsen after 3-5 days, consult a healthcare provider. Topical steroids can be applied to the external vulvar area but should not be used internally without medical supervision, and they work by reducing inflammation and itching, however, prolonged use can thin the skin, so follow recommended usage guidelines. For severe or persistent symptoms, a doctor may prescribe stronger topical steroids or investigate other potential causes such as infections or skin conditions, and alternative therapies like cryotherapy, ultraviolet phototherapy, or carbon dioxide laser vaporization may be considered 1.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis temporarily relieves external anal and genital itching Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily

Vulvar swelling and pain possibly due to an allergic reaction can be caused by various factors such as:

• Skin irritations
• Inflammation
• Rashes due to eczema, psoriasis, poison ivy, oak, sumac, insect bites, detergents, jewelry, cosmetics, soaps, or seborrheic dermatitis. For management, topical steroids like hydrocortisone can be applied to the vulvar area. The treatment involves:
• Cleaning the affected area with mild soap and warm water
• Gently drying the area by patting or blotting with toilet tissue or a soft cloth
• Applying the topical steroid to the affected area not more than 3 to 4 times daily 2 2

From the Research

Causes of Vulvar Swelling and Pain

• Vulvar pain can be caused by various factors, including neuropathy, referred pain, and pelvic floor muscle dysfunction 3
• Inflammatory vulvar dermatoses, such as contact dermatitis, lichen simplex chronicus, lichen sclerosus, and lichen planus, can also cause vulvar pain and swelling 4, 5
• Allergic reactions can cause contact dermatitis, which is a common cause of vulvar pain and swelling 4, 5

Treatment Options

• Topical corticosteroids are commonly used to decrease inflammation and manage symptoms of inflammatory vulvar dermatoses 4, 5
• However, corticosteroids are considered to be one of the least effective treatments for vulvodynia, a condition characterized by chronic vulvar pain 6
• A combined treatment approach using multiple types of drugs, including antidepressants and anticonvulsants, may be more effective in managing vulvar pain 6
• Gentle skin care and behavioral changes can also help manage symptoms of inflammatory vulvar dermatoses 4

Management of Vulvar Pain

• Accurate diagnosis of the cause of vulvar pain is essential for effective management 3
• Ruling out underlying conditions, such as vulvar skin disease or vulvovaginal infection, is crucial before diagnosing vulvodynia 3
• Treatment of vulvar pain should be individualized and may involve a combination of medical and behavioral therapies 6, 3