From the Guidelines
Vaginal contact dermatitis, also known as allergic contact dermatitis, should be diagnosed through patch testing and treated by identifying and removing the offending agent, and applying a low-potency topical corticosteroid such as 1% hydrocortisone cream to the affected external areas twice daily for 3-7 days. The condition is an inflammatory skin reaction in the vaginal area caused by irritants or allergens, and its diagnosis is crucial to prevent further complications. According to the guidelines of care for the management of atopic dermatitis, allergic contact dermatitis is a type IV/delayed-type hypersensitivity reaction to small environmental chemicals, and its prevalence is high in individuals with atopic dermatitis 1.
Diagnosis and Treatment
The most common contact allergens include nickel, neomycin, fragrance, formaldehyde, and other preservatives, lanolin, and rubber chemicals 1. Diagnosis is by patch testing, whereby suspected allergens are placed on unaffected skin, typically the back, for 48 hours. Presence of a reaction should be assessed at the time of initial patch removal and again at a later time point, up to 7 days after application, for delayed reactions.
- Patch testing should be considered in cases where a history and/or physical exam is suggestive of ACD, such as disease aggravated by topical medications or emollients or patterns that reflect application of, or exposure to, a consistent item.
- Testing may also be considered where there is an unusual and atypical distribution of lesions for AD, if there is later onset of disease or new significant worsening, if there is no family history of atopy, and in those with persistent/recalcitrant disease not responding to standard AD therapies.
- Avoidance of the suspected allergen with resolution of the corresponding dermatitis confirms the diagnosis of ACD.
Prevention and Management
Prevention involves using fragrance-free, hypoallergenic products, cotton underwear, and avoiding potential irritants. Soothing measures include cool compresses, sitz baths with colloidal oatmeal, and wearing loose cotton underwear. Antihistamines like cetirizine 10mg daily may help reduce itching. If symptoms persist beyond a week, worsen, or recur frequently, medical evaluation is necessary to rule out other conditions like infections or more serious skin disorders. The condition occurs because the sensitive vaginal tissue has a thinner epithelial layer and different pH than other skin, making it more susceptible to irritation and immune responses to allergens, resulting in the characteristic redness, itching, burning, and sometimes swelling.
From the Research
Diagnosis of Vaginal Contact Dermatitis
- The diagnosis of vaginal contact dermatitis, also known as allergic contact dermatitis, involves a comprehensive evaluation of the patient's symptoms and medical history 2, 3.
- Patch testing is required to identify relevant contact allergens, which can include medicaments, preservatives, and fragrances 2.
- Common causes of vulvar pruritus, such as candidiasis, contact dermatitis, and lichen simplex chronicus, should be considered in the diagnosis 4.
- Differentiating factors, including itching, erythema, and persistence, can help diagnose allergic contact dermatitis of the vagina and perineum 3.
Treatment of Vaginal Contact Dermatitis
- Treatment of vaginal contact dermatitis involves avoiding irritants and allergens, and using topical corticosteroids to control symptoms 4, 5.
- Patient education and follow-up are essential in optimizing treatment and preventing recurrence of vulvar contact dermatitis 2.
- A multidisciplinary approach to treatment, including careful attention to irritants and secondary infections, can help prevent chronicity 4.
- The American College of Obstetricians and Gynecologists provides updated diagnostic and management recommendations for vulvar skin conditions, including contact dermatitis, in their Practice Bulletin 6.