From the Guidelines
For pruritus vulvae, the most effective topical cream is clotrimazole 1% or 2% cream, which can be applied intravaginally daily for 3-14 days, as it has been shown to be effective in treating vulvovaginal candidiasis, a common cause of vaginal itching, according to the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
When considering treatment options for pruritus vulvae, it is essential to note that the diagnosis of vulvovaginal candidiasis can be made clinically, but confirmation with a wet-mount preparation or vaginal culture is recommended to rule out other causes of itching 1.
- Over-the-counter antifungal creams, such as clotrimazole, miconazole, or tioconazole, are often effective in treating yeast infections, which are a common cause of vaginal itching.
- For non-fungal causes of itching, hydrocortisone cream (0.5-1%) can provide temporary relief from irritation, but should not be used inside the vagina.
- Products specifically designed for vaginal irritation, such as Vagisil, contain local anesthetics that can provide immediate relief.
Important Considerations
It is crucial to note that if the itching persists beyond a week, is severe, or is accompanied by unusual discharge, odor, or pain, consultation with a healthcare provider is necessary, as it may indicate a different condition requiring prescription treatment 1.
- Maintaining good hygiene with mild, unscented soap and wearing cotton underwear can help prevent recurrence by keeping the area dry and reducing irritation.
- The 2016 clinical practice guideline for the management of candidiasis by the Infectious Diseases Society of America recommends that treatment should not differ based on HIV infection status, and identical response rates are anticipated for HIV-positive and HIV-negative women 1.
From the FDA Drug Label
Do not scratch the skin outside the vagina. Scratching can cause more irritation and can spread the infection. Use the cream twice daily, for up to 7 days as needed. Apply the cream onto the skin outside the vagina (vulva) that itches and is irritated. External Vulvar Cream: miconazole nitrate, 2% The best topical cream for pruritus vulvae (vulvar itching) is miconazole nitrate, 2% cream, as it is specifically indicated for relief of itching and irritation on the skin outside the vagina (vulva) due to a yeast infection 2.
From the Research
Topical Creams for Pruritus Vulvae
- Pruritus vulvae, or vulvar itching, can be caused by various conditions, including vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis 3
- Topical creams can be an effective treatment for vulvar itching, especially for fungal infections such as vulvovaginal candidiasis
Treatment Options
- Clotrimazole 1% cream has been shown to be effective in treating vulvovaginal candidiasis, with a success rate of 75% in one study 4
- Miconazole nitrate 2% cream is also a common treatment for vulvovaginal candidiasis, and can be applied twice daily to the vulvar area for external symptoms 5
- Mycozin vaginal cream has been compared to Clotrimazole 1% cream in a triple-blinded randomized controlled trial, and was found to be a suitable alternative for patients interested in herbal medicines and resistant to azole compounds 6
Efficacy and Safety
- The efficacy and safety of topical creams for pruritus vulvae can vary depending on the specific condition being treated and the individual patient 7
- Clotrimazole 1% cream has been shown to have a slightly better efficacy than miconazole nitrate 2% cream in some studies, but the difference is not always statistically significant 4, 6
- Mycozin vaginal cream has been found to have a positive effect in eliminating symptoms and signs associated with vaginal candidiasis, and can be used as a suitable alternative to azole compounds 6