From the Research
The treatment for Desquamative Inflammatory Vaginitis (DIV) primarily involves topical clindamycin 2% cream or intravaginal corticosteroids, with the most recent and highest quality study suggesting that treatment with topical 2% clindamycin or 10% hydrocortisone dramatically relieves symptoms within 3 weeks in 86% of patients 1. The standard regimen is clindamycin 2% cream applied intravaginally once daily for 2-3 weeks, followed by a maintenance regimen of 2-3 times weekly for 2-3 months. Alternatively, hydrocortisone 10% vaginal cream or other corticosteroid preparations can be used once daily for 2-3 weeks. Some key points to consider when treating DIV include:
- The condition is characterized by an altered vaginal microbiome with reduced lactobacilli and increased parabasal cells, which explains why antibiotics like clindamycin are effective despite the absence of specific pathogens 2.
- The anti-inflammatory properties of both clindamycin and corticosteroids help reduce the epithelial inflammation and restore normal vaginal flora.
- Patients should be advised to avoid potential irritants such as scented products, douches, and tight-fitting clothing during treatment.
- Follow-up evaluation is recommended after 2-3 weeks of treatment to assess response, and maintenance therapy may be needed for several months to prevent recurrence 1. It's also important to note that DIV is a chronic inflammatory process involving both vagina and vestibule, occurring almost exclusively in white women, and responds well to topical anti-inflammatory therapy, although long-term maintenance therapy frequently is required 1.