Understanding Vulvar Eczema

One cause of this itching is vulvar eczema. We explain this uncomfortable condition, what causes it, and your treatment options.

What is vulvar eczema?

Eczema, also called atopic dermatitis, is a common skin condition that causes itchy and red patches on the skin. Vulvar eczema is eczema that is on the external area around the vagina. It is also typically not limited to the vulva, but may also be around the anal opening and between the buttocks.

There are three types of eczema that affect the vulva:

• atopic eczema
• allergic eczema
• irritant contact eczema

The condition usually causes the skin to be sore, itchy, and red. Since there are many different causes of this in the vulvar area, it’s important that a doctor looks at it to rule out things like a yeast infection or sexually transmitted infection (STI).

What are the symptoms of vulvar eczema?

Symptoms of vulvar eczema are similar to other types of eczema, and can include:

• dry, scaly patches
• redness
• itching

If the vulvar eczema is due to an irritant, you may also have vaginal or vulvar burning.

How is vulvar eczema diagnosed?

If you have a vulvar rash or irritation and think it might be eczema, see a doctor. As part of your exam, they will look at the area and take a complete medical history. They may also be able to recognize eczema from just looking at it.

Since there is no specific test for eczema, most of the diagnosis has to do with viewing the area and ruling out other conditions. The doctor will also ask about hormone medications, since the skin around the genitals is influenced by sex hormones.

If you have discharge, they may swab the area, or they may do a skin scraping for testing at a lab. If they suspect a sexually transmitted infection, they may do a blood test for STI testing.

They may also do a vulvoscopy, which is when the doctor looks at the vulva with an instrument that magnifies the skin, with a light attached. This, along with applying an acetic acid formula to check for abnormal areas, can help them rule out other conditions.

If your doctor suspects eczema, they will identify and remove the offending irritants or allergens. This can be achieved with a “skin diet” — removing all topicals and using only a few hypoallergenic products.

Your doctor may also perform “patch testing” — skin testing that helps identify allergies.

What is the treatment for vulvar eczema?

As with other types of eczema, vulvar eczema requires good, gentle skin care — even when the skin returns to normal. This includes wearing cotton underwear, avoiding tight clothing, and using fingers to clean instead of a washcloth. Avoiding cleaning products with multiple ingredients can also help reduce the risk of a skin reaction.

Mild cases can be treated with a topical corticosteroid cream twice daily for two to four weeks, and then slowly reducing the application until the symptoms have resolved. More severe cases may need a stronger corticosteroid cream. You may also use an antihistamine at night to reduce itching. During the day, a cold pack can help to reduce the itch.

Steroid-sparing medications for the skin, like pimecrolimus and tacrolimus, may be used for maintenance or to help keep your skin clear.

What causes vulvar eczema?

Vulvar eczema typically appears because of an irritant or allergen. These can include:

• soap, bubble baths, or detergent
• adult/baby wipes
• panty liners
• nylon underwear
• vaginal secretions or sweat
• spermicides or lubricants
• fragrances
• latex
• tea tree oil

What are the risk factors for developing vulvar eczema?

There are a variety of risk factors for developing vulvar eczema. These can include:

• emotional stress
• physical irritants
• too much soap, especially perfumed soap
• family history of eczema
• wearing nylon underwear
• wearing tight pants

What’s the outlook for people with vulvar eczema?

Vulvar eczema may not always be able to be prevented, but it can be easily treated. Antihistamines and cortisone/corticosteroid creams can help with itching and redness and help to clear up the skin.

Symptoms can also be effectively managed. Changing some things about your skin care or bathing routine can make a big difference.

Stress can sometimes trigger eczema or make it worse, so it’s also important to manage stress in healthy ways, like regular exercise, getting enough sleep, or making time for relaxation.

The bottom line

Vulvar eczema is uncomfortable, but getting an accurate diagnosis is the first step to learning how to manage it and treat it, as well as reduce your risk for future flare-ups.

Talk with your doctor about possible triggers for your eczema and ways you can take care of your vulvar area even when there is no flare-up. They can also tell you about various treatments that are available depending on the severity of your eczema flare-up.

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