Differential Diagnosis for Vulvar Burning, Irritation, and Pain

• Single Most Likely Diagnosis
  • Irritant contact dermatitis: This is the most likely diagnosis given the patient's history of using scented panty liners, which can cause irritation, especially in the vulvar area. The symptoms of burning, irritation, and pain are consistent with this diagnosis.
• Other Likely Diagnoses
  • Atrophic vaginitis (vulvar atrophy): Although the patient denies internal vaginal symptoms, atrophic vaginitis can cause external vulvar irritation and pain, especially in postmenopausal women.
  • Urinary incontinence-associated dermatitis: The patient's history of urinary leakage and use of panty liners increases the risk of skin irritation and dermatitis.
  • Candidal intertrigo: This is a type of fungal infection that can occur in warm, moist areas of the body, such as the vulva. It can cause burning, irritation, and pain.
• Do Not Miss Diagnoses
  • Vulvar cancer: Although rare, vulvar cancer can cause persistent vulvar irritation, pain, and bleeding. It is essential to rule out this diagnosis, especially in older adults.
  • Lichen sclerosis: This is a chronic skin condition that can cause vulvar itching, burning, and pain. If left untreated, it can increase the risk of vulvar cancer.
  • Herpes simplex virus (HSV) infection: Although the patient is not sexually active, it is still possible to contract HSV through non-sexual contact. HSV can cause painful vulvar ulcers and irritation.
• Rare Diagnoses
  • Lichen planus: This is a rare skin condition that can cause vulvar itching, burning, and pain.
  • Psoriasis: This is a chronic skin condition that can cause vulvar itching, burning, and pain, although it is rare in the vulvar area.
  • Allergic contact dermatitis: This is a rare condition that occurs when the skin comes into contact with an allergen, causing an immune response and resulting in irritation and pain.