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Hydrocortisone cream for vulvar itching11/16/2023 ![]() If no underlying condition is identified as the cause of pruritus in patients with suspected lichen simplex chronicus, breaking the itch-scratch cycle is the key to therapy. 23 – 26Ĭonsistent findings from large prospective studies and recommendations from evidence-based guidelines Patients with lichen sclerosus should be treated with a high-potency steroid ointment to alleviate symptoms, prevent architectural damage, and reverse histologic changes. 18, 20, 25įindings from large epidemiologic studies and expert consensus 6 – 8Ĭonsistent findings from randomized controlled trials and systematic reviewsīiopsy is indicated for patients with suspected lichen sclerosus because this condition is associated with an increased risk of squamous cell carcinoma. Low-dose intravaginal estrogen is the preferred hormonal treatment for vulvar manifestations of genitourinary syndrome of menopause. A multimodal treatment approach typically includes vulvar hygiene, physical therapy, psychosocial interventions, and antineuropathy medications. Vulvodynia is a common vulvar pain disorder and is a diagnosis of exclusion. Breaking the itch-scratch cycle, often with topical steroids, is the key to treatment. Lichen simplex chronicus manifests as persistent itching and scratching of the vulvar skin that leads to thickened epithelium. ![]() The first-line treatment is topical steroids, and significant scarring can occur if left untreated. Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and vagina in addition to other skin and mucosal surfaces. Patients with lichen sclerosus are at risk of vulvar squamous cell carcinoma and should be monitored closely for malignancy. It is treated with topical steroids or, in some cases, topical calcineurin inhibitors. ![]() Lichen sclerosus is an inflammatory condition characterized by intense vulvar itching. It is typically treated with lubricants, moisturizers, and intravaginal estrogen. Genitourinary syndrome of menopause results from the hypoestrogenic state that leads to atrophy of normal vulvar and vaginal tissues. If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.Common benign chronic vulvar conditions include genitourinary syndrome of menopause (formerly called vulvovaginal atrophy), lichen sclerosus, lichen planus, lichen simplex chronicus, and vulvodynia. In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted. Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids.Ĭhildren may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity (see PRECAUTIONS - Pediatric Use). Recovery of HPA axis function is generally prompt and complete upon discontinuation of the drug. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid. Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. Conditions which augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings. Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients. ![]() Some of the topical corticosteroids and their metabolites are also excreted into the bile. Corticosteroids are metabolized primarily in the liver and are then excreted by the kidneys. Corticosteroids are bound to plasma proteins in varying degrees. Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systematically administered corticosteroids. Thus, occlusive dressings may be a valuable therapeutic adjunct for treatment of resistant dermatoses (see DOSAGE AND ADMINISTRATION). Occlusive dressings substantially increase the percutaneous absorption of topical corticosteroids. Inflammation and/or other disease processes in the skin increase percutaneous absorption. Topical corticosteroids can be absorbed from normal intact skin. The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle, the integrity of the epidermal barrier, and the use of occlusive dressings.
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