Vulvar Itching: Causes, Symptoms, and Treatment Options

Vulvar itching

Hello Dr.
Huang, the content may be a bit lengthy, but I want to provide detailed information so you can better understand my situation.
I have been experiencing chronic itching symptoms, and I have had my blood sugar tested, which was slightly elevated but still within the normal range.
Therefore, I have been moderating my intake of sweets and beverages, but the symptoms continue to recur.

In the past few months, the itchy skin sometimes becomes swollen and feels somewhat firm yet smooth.
However, it does not swell into a lump but rather takes on an irregular shape.
This condition has occurred several times.
Yesterday, after an examination, the doctor said that I had scratched the skin, leading to mild cellulitis.
The doctor mentioned that if my condition worsens, I might need to go to the emergency room and prescribed antibiotics and an ointment for me to apply.
I am to return for a follow-up to see if there are any signs of spreading.
The doctor indicated that my itching issue is eczema, but due to scratching, it has developed into cellulitis.
After returning home, I researched the symptoms of acute vulvar cellulitis, which primarily include redness, swelling, heat, and severe pain, along with a possible elevated body temperature.
During the consultation, the doctor also asked if I was in pain, and I told him it wasn't very painful, just very itchy, so I received an oral antihistamine to take home.
There are still five days until my follow-up appointment.
I previously mentioned that this situation has occurred several times, with each episode starting after I scratched the area, leading to swelling and unbearable itching.
However, after a few days, it subsides, only to recur with the same symptoms.
Unable to tolerate it any longer, I went to see the doctor.
I would like to ask you, Dr.
Huang, does vulvar cellulitis cause severe itching symptoms? It is quite itchy, and although the wound has stopped bleeding, I sometimes accidentally scratch it until it bleeds again.
The hospital only prescribed three oral antihistamines for me.
I would like to know how I can avoid scratching the affected area, as I always feel very itchy and want to scratch the wound.

Yue, 30~39 year old female. Ask Date: 2019/10/26

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In the past few months, I have experienced itchy skin that sometimes swells and feels somewhat firm yet smooth to the touch.
However, it does not swell into a single lump but rather takes on an irregular shape.
This condition has occurred several times, and after visiting a doctor yesterday for an internal examination, I was informed that I had scratched the skin, leading to mild cellulitis.
The doctor mentioned that if my condition worsens, I might need to go to the emergency room.
I was prescribed antibiotics and an ointment to apply, and I am to return for a follow-up to check for any signs of spreading.
The doctor also indicated that my underlying itching issue is eczema, but the scratching has resulted in cellulitis.

After returning home, I researched the symptoms of acute vulvar cellulitis, which primarily include redness, swelling, heat, and severe pain, along with a possible elevated body temperature.
During the consultation, the doctor asked if I was in pain, and I only mentioned that it wasn't very painful but quite itchy, so I received an oral antihistamine for the itching.
There are still five days until my follow-up appointment, and I previously mentioned that this condition has occurred multiple times, always following scratching that resulted in wounds and intense itching in the swollen areas.
However, after a few days, the symptoms subside, only to reappear again.
After enduring this, I decided to see a doctor.

I would like to ask Dr.
Huang: Does vulvar cellulitis cause severe itching? The itching from the scratched wounds, which led to vulvar cellulitis, is quite bothersome.
Although the wounds are no longer bleeding, I sometimes accidentally scratch them again, causing bleeding.
The hospital only prescribed three oral antihistamines for the itching, and I would like to know how I can avoid scratching the affected area, as I always feel an intense urge to scratch the wounds.

Answer: Apply the ointment.

Reply Date: 2019/10/26

More Info

Vulvar itching can be a distressing condition, and understanding its causes, symptoms, and treatment options is crucial for effective management. Based on your description, it appears that you are experiencing a chronic itching condition that has led to skin damage and secondary infections, specifically cellulitis (蜂窩性組織炎).

Causes of Vulvar Itching
1. Eczema/Dermatitis: As your doctor mentioned, eczema can cause intense itching and inflammation in the vulvar area. This condition can be exacerbated by irritants such as soaps, detergents, or even certain fabrics.

2. Infections: Fungal infections (like yeast infections) and bacterial infections can lead to itching and discomfort. The fact that you have developed cellulitis indicates that there was a break in the skin, allowing bacteria to enter.

3. Allergic Reactions: Allergies to personal care products, laundry detergents, or even certain foods can trigger itching.

4. Hormonal Changes: Fluctuations in hormones, particularly during menstrual cycles or menopause, can lead to dryness and itching.

5. Diabetes: You mentioned having slightly elevated blood sugar levels. Diabetes can increase the risk of infections, including yeast infections, which can cause vulvar itching.

Symptoms
The symptoms you describe—itching, swelling, and irregular-shaped hard areas—are consistent with eczema or dermatitis. The presence of redness and swelling, especially after scratching, suggests inflammation. The fact that you have experienced skin breaks leading to cellulitis is concerning, as this can lead to more serious complications if not managed properly.

Treatment Options
1. Topical Treatments: Your doctor has prescribed antibiotics and topical ointments to manage the cellulitis. It's essential to follow this treatment to prevent further infection. Additionally, topical corticosteroids may help reduce inflammation and itching associated with eczema.

2. Oral Antihistamines: These can help alleviate itching and may assist in reducing the urge to scratch. However, as you noted, you received only a limited supply. Discuss with your doctor the possibility of a longer course or alternative medications.

3. Moisturizers: Regularly applying a fragrance-free moisturizer can help soothe the skin and reduce dryness, which may alleviate itching.

4. Avoiding Irritants: Identify and avoid any potential irritants, such as harsh soaps, scented products, or tight clothing that may exacerbate your symptoms.

5. Behavioral Strategies: To prevent scratching, consider wearing gloves at night or using cold compresses to soothe the area. Keeping your nails short can also minimize damage if you do scratch.

6. Follow-Up Care: Since your condition has been recurrent, it is crucial to have regular follow-ups with your healthcare provider. They may consider further evaluation for underlying conditions, such as diabetes management or allergy testing.

Conclusion
Vulvar itching, especially when complicated by secondary infections like cellulitis, requires a comprehensive approach to treatment. It is essential to adhere to your prescribed medications and follow up with your healthcare provider to monitor your condition. If the itching persists or worsens, or if you develop new symptoms, seek medical attention promptly. Managing underlying conditions, avoiding irritants, and employing effective topical treatments can significantly improve your quality of life and reduce the frequency of flare-ups.

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