Differential Diagnosis for a 60-year-old Female with Nighttime Pruritis and Vulva Obliteration
- Single Most Likely Diagnosis
- A. Atrophic vaginitis: This condition is common in postmenopausal women due to decreased estrogen levels, leading to thinning and drying of the vaginal walls. Symptoms include vaginal dryness, itching (pruritis), and pain during intercourse. The absence of white spots and the failure of over-the-counter medications to relieve symptoms, along with the patient's age, make atrophic vaginitis a strong consideration.
- Other Likely Diagnoses
- B. Lichen planus: This is an inflammatory condition that can affect the skin and mucous membranes, including the vulva. It can cause itching, pain, and changes in the appearance of the vulva, such as whitish patches or erosions. However, the question stem mentions "no white spots," which might make lichen planus less likely, but it cannot be ruled out without further examination.
- Do Not Miss Diagnoses
- Vulvar cancer: Although less common, vulvar cancer can present with itching, pain, and changes in the vulvar appearance. It's crucial to consider this diagnosis, especially in older women, as it can be life-threatening if not diagnosed and treated promptly.
- Invasive fungal infections: In diabetic or immunocompromised patients, invasive fungal infections can occur and present with severe vulvar symptoms. These conditions are serious and require immediate medical attention.
- Rare Diagnoses
- Zinc deficiency: Although rare, zinc deficiency can cause skin lesions and itching. It's an unlikely cause of the symptoms described but could be considered if other diagnoses are ruled out and the patient has a history or signs suggestive of zinc deficiency.
- Crohn's disease or ulcerative colitis with perianal involvement: These conditions can cause itching, pain, and changes in the perianal area, including the vulva, but are less common causes of the symptoms described in the question stem.