From the Research
The recommended treatment for recurring Desquamative Inflammatory Vaginitis (DIV) is a combination of clindamycin 2% vaginal cream and a topical steroid, such as hydrocortisone 1% or clobetasol 0.05% cream, applied intravaginally once or twice daily for 2-4 weeks, as supported by the most recent study 1.
Treatment Overview
The treatment of recurring DIV typically involves a combination of antimicrobial and anti-inflammatory agents.
- Clindamycin 2% vaginal cream is used to address the potential microbial cause of the condition.
- Topical steroids, such as hydrocortisone 1% or clobetasol 0.05% cream, are used to reduce inflammation.
Maintenance Therapy
After initial treatment, maintenance therapy may be necessary with less frequent applications (2-3 times weekly) for several months to prevent recurrence, as noted in 2.
Severe or Persistent Cases
For severe or persistent cases, oral clindamycin 300mg twice daily for 7-14 days may be added, as suggested by 3.
Additional Considerations
Some clinicians also use intravaginal estrogen therapy (such as estradiol vaginal cream 0.01%, 1-2g applied 2-3 times weekly) alongside antimicrobial treatment, particularly in postmenopausal women, as estrogen helps maintain vaginal epithelial integrity, as mentioned in 4.
Key Points
- Recurrent DIV often requires longer treatment courses and maintenance therapy compared to initial episodes.
- The condition is believed to result from an altered vaginal microbiome and inflammatory response, with decreased lactobacilli and increased pH.
- Regular follow-up is important to monitor response and adjust treatment as needed, with some patients requiring intermittent or long-term maintenance therapy to control symptoms, as highlighted in 1.