From the Guidelines
Vaginal contact dermatitis should be diagnosed and treated by identifying and removing the offending agent, and using topical corticosteroids and oral antihistamines to reduce inflammation and itching, as recommended by the most recent guidelines 1. The diagnosis of vaginal contact dermatitis involves a detailed history and careful evaluation to determine the cause of the inflammation, which can be caused by irritants or allergens such as soaps, detergents, lubricants, spermicides, or feminine hygiene products. Key steps in treatment include:
- Identifying and removing the offending agent
- Applying cool compresses to the affected area and taking sitz baths with lukewarm water for 10-15 minutes several times daily
- Using topical corticosteroids like 1% hydrocortisone cream applied thinly to the external genital area twice daily for up to 7 days
- Using oral antihistamines such as cetirizine 10mg daily or diphenhydramine 25mg every 6 hours to control itching
- Avoiding potential irritants by using fragrance-free products, cotton underwear, and mild, unscented soaps It is essential to seek medical attention if symptoms persist beyond 1-2 weeks despite treatment, worsen, or are accompanied by discharge or fever, as this could indicate another condition like a vaginal infection 1. Patch testing may be considered in cases where a history and/or physical exam is suggestive of allergic contact dermatitis, such as disease aggravated by topical medications or emollients, or patterns that reflect application of, or exposure to, a consistent item 1. The sensitivity of patch testing ranges from 60-80% in reports, and positive patch tests only indicate contact sensitization and need demonstrated relevance to the patient's active dermatitis 1.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... temporarily relieves external anal and genital itching Directions for ... external anal and genital itching, adults: ... apply to affected area not more than 3 to 4 times daily Warnings For external use only Do not use in the genital area if you have a vaginal discharge. Consult a doctor.
The diagnosis of vaginal contact dermatitis is not explicitly stated in the provided drug labels. The treatment for vaginal contact dermatitis may involve the use of hydrocortisone, but it is crucial to note that the labels warn against using the product in the genital area if there is a vaginal discharge, and advise consulting a doctor in such cases 2, 2, 2.
- For external anal and genital itching, the product can be applied to the affected area not more than 3 to 4 times daily, but it is essential to follow the instructions and precautions outlined in the labels.
- It is also important to consult a doctor before using the product, especially if the condition worsens or persists 2.
From the Research
Diagnosis of Vaginal Contact Dermatitis
- Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance 3.
- There are two forms of contact dermatitis: irritant and allergic, with irritant contact dermatitis being more common in the vulvar area 4.
- Comprehensive and specific questioning about hygiene practices and product use is necessary to elicit a history of contactant use 4.
- Patch testing is required to identify relevant contact allergens, the most common of which include medicaments, preservatives, and fragrances 4, 5.
Treatment of Vaginal Contact Dermitis
- Localized acute allergic contact dermatitis lesions are successfully treated with mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05% 3.
- If allergic contact dermatitis involves an extensive area of skin (greater than 20 percent), systemic steroid therapy is often required and offers relief within 12 to 24 hours 3.
- Patient education and follow-up are essential in optimizing treatment and preventing recurrence of vulvar contact dermatitis 4.
- Allergic contact dermatitis is a frequent finding in patients presenting with vulvar symptoms, and fragrances, medicaments, and preservatives are the most commonly implicated allergens 5, 6.