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Clinical investigations from the RACP

Vulval itch: all that itches is not thrush

Asiye Doxanakis, Catriona Bradshaw, Chris K Fairley

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Abstract

About one in ten women will at some time present with persistant vulval itch. Possible causes include infections such as thrush and trichomoniasis, primary dermatoses such as dermatitis and psoriasis and, more rarely, malignancy or premalignant disease.

Key Points

  • Vulval itch is the predominant complaint in women presenting with external genital symptoms.
  • Common causes of vulval itch are vulvovaginal candidiasis and dermatoses.
  • Lichen sclerosus, vulval intraepithelial neoplasia and vulval cancer are important, although uncommon, causes of vulval itch (red flag conditions).
  • A thorough history and examination are essential and dictate investigations.
  • First line management of vulval itch involves the removal of irritants and implementation of good skin care.
  • Conditions that fail to respond to treatment or red flag conditions should be referred for biopsy and management.

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