Evaluation of patch testing in patients with chronic vulvar symptoms

A systematic review of allergic and irritant contact dermatitis of the vulva: The most important allergens/irritants and the role of patch testing

Vulvar allergic contact dermatitis (vACD) and irritant contact dermatitis (vICD) are common and accompanied by a great burden on the patient's life. We aimed to review the existing literature on vACD and vICD in order to provide a comprehensive reference list of potential vulvar allergens and irritants, as well as to establish the role of patch testing therein. A systematic search was performed in Medline, Embase and Web of Science using a search string based on the PICO-format. The study protocol was registered at PROSPERO (CRD42021239527). Multiple allergens were identified and included metals, topical drugs, fragrances, preservatives, cosmetic constituents and rubber components. Not all positive reactions were, however, considered to be relevant. Patch testing is the primary tool for the identification of the causal allergens. Testing with standard series alone was proven to be insufficient. Little information about irritants was found. In the future, additional series and late readings should be considered in standard practice. Studies on vICD are scarce and further research is necessary. More population-based research should be performed.

Contact Dermatitis of the Vulva

The vulvar area is a common site of both irritative and allergic contact dermatitis due to the thin skin, easily traversable by irritant and allergic substances. The purpose of this review is to provide an overview of the most frequent allergens causing contact dermatitis in this particular site. A literature search was conducted via PubMed through May 2021. Relevant English language studies are included in this review. Fragrances, preservatives, botanical products, and topical medicaments were found to be the most commonly involved allergens. Contact dermatitis is a very common occurrence that should also be considered in patients with chronic vulvar or anogenital dermatitis who do not respond to appropriate treatments.

Allergic Contact Dermatitis of the Anogenital Region in Men and Women

OBJECTIVES

Allergic contact dermatitis is an uncommon but important cause of skin disease in the anogenital region. Relevant allergens are described in women and less commonly in men. The aim of this study was to describe outcomes of patch testing in men and women presenting with anogenital dermatoses.

MATERIALS AND METHODS

Cases patch tested for anogenital conditions at 2 patch test clinics in Sydney, Australia, from 2002 to 2017 were reviewed. Positive and relevant patch test reactions were recorded.

RESULTS

Thirty-seven women and 27 men were included. Dermatitis was the most common diagnosis, followed by psoriasis and lichen sclerosus. Thirty percent had a final diagnosis of allergic contact dermatitis. The most frequent relevant allergens were fragrance mix I (9%), patients own products (9%), Myroxylon pereirae (8%), cocamidopropyl betaine (3%), and benzocaine (3%).

CONCLUSIONS

The top positive and relevant allergens seen were in concordance with other reports from Australia and the rest of the world. Fragrances and medicaments are common allergens, and it is recommended that products used on anogenital skin be fragrance free. Testing patients own products is imperative.

Allergic contact dermatitis of the vagina and perineum: causes, incidence of, and differentiating factors

Review of allergic contact dermatitis of the vagina and perineum, including causes, incidence of, and differentiating factors. The causes include common allergens found in everyday products. The true incidence of contact dermatitis of the vagina and perineum is unknown, however, it is a common problem facing clinicians. The differentiating factors include itching, erythema, and persistence.

Vulvar dermatosis

Vulvar dermatoses are inflammatory conditions responsible for chronic or recurrent itching and soreness. The lesions are either circumscribed to the vulva or associated with extragenital localizations which may help to assess the diagnosis. They should be differentiated from infectious or neoplastic diseases which may have clinical similarities. As opposed to the majority of all dermatoses that have a benign and regular course, lichen sclerosus or lichen planus could exceptionally foster the occurrence of an epithelial cancer precursor which may evolve to squamous cell carcinoma. Topical corticosteroids are the mainstay treatment of vulvar dermatosis. We do not know if the treatment of vulvar lichen sclerosus and vulvar lichen planus prevents squamous cell carcinoma.

A review of the toxicity of Melaleuca alternifolia (tea tree) oil

The essential oil of Melaleuca alternifolia, also known as tea tree or melaleuca oil, is widely available and has been investigated as an alternative antimicrobial, anti-inflammatory and anti-cancer agent. While these properties are increasingly well characterised, relatively limited data are available on the safety and toxicity of the oil. Anecdotal evidence from almost 80 years of use suggests that the topical use of the oil is relatively safe, and that adverse events are minor, self-limiting and occasional. Published data indicate that TTO is toxic if ingested in higher doses and can also cause skin irritation at higher concentrations. Allergic reactions to TTO occur in predisposed individuals and may be due to the various oxidation products that are formed by exposure of the oil to light and/or air. Adverse reactions may be minimised by avoiding ingestion, applying only diluted oil topically and using oil that has been stored correctly. Data from individual components suggest that TTO has the potential to be developmentally toxic if ingested at higher doses, however, TTO and its components are not genotoxic. The limited ecotoxicity data available indicate that TTO is toxic to some insect species but more studies are required.

In vitro and in vivo killing of ocular Demodex by tea tree oil

AIMS

To compare the in vitro killing effect of different agents on Demodex and to report the in vivo killing effect of tea tree oil (TTO) on ocular Demodex.

METHODS

Survival time of Demodex was measured under the microscope. Sampling and counting of Demodex was performed by a modified method.

RESULTS

Demodex folliculorum survived for more than 150 minutes in 10% povidone-iodine, 75% alcohol, 50% baby shampoo, and 4% pilocarpine. However, the survival time was significantly shortened to within 15 minutes in 100% alcohol, 100% TTO, 100% caraway oil, or 100% dill weed oil. TTO's in vitro killing effect was dose dependent. Lid scrub with 50% TTO, but not with 50% baby shampoo, can further stimulate Demodex to move out to the skin. The Demodex count did not reach zero in any of the seven patients receiving daily lid scrub with baby shampoo for 40-350 days. In contrast, the Demodex count dropped to zero in seven of nine patients receiving TTO scrub in 4 weeks without recurrence.

CONCLUSIONS

Demodex is resistant to a wide range of antiseptic solutions. Weekly lid scrub with 50% TTO and daily lid scrub with tea tree shampoo is effective in eradicating ocular Demodex.

Inflammatory dermatoses of the vulva

Inflammatory, non-neoplastic epidermal alterations of the vulva can be correctly diagnosed using classification schemes applied to skin elsewhere on the body. A wide range of inflammatory disorders may occur on the vulva, and they may have a similar clinical presentation to HPV lesions. However, HPV is incurable and often is treated surgically. Accordingly, as inflammatory dermatoses commonly occur on the vulva and are often curable with topical therapy, an awareness of these entities and an ability to distinguish them from HPV are imperative.

Vulvar Dermatoses – Irritant and Allergic Contact Dermatitis of the Vulva

Irritant and allergic contact dermatitis are commonly seen in patients complaining about itching, burning and irritation in the vulvar area. Irritation often precedes allergic sensitization. Clinically, irritant and allergic contact dermatitis can be difficult to distinguish. Diagnosis is made by history, clinical investigation and patch testing. Recommended patch test series are the standard series, a medicament series, the patient's own topical medicaments, popular remedies and other suspected products. A skin biopsy may be useful to establish the diagnosis of contact dermatitis, but it is usually not helpful for the differential diagnosis between irritant and allergic dermatitis.

Contact dermatitis of the vulva

Vulvar diseases rarely stand alone. They are often caused or worsened by primary irritant or allergic contact dermatitis, and this should be considered when evaluating any vulvar complaint. All irritants should be avoided in all women, and those with vulvar dermatoses should be patch tested to help define or rule out allergens.

Symptoms and HPV infection of the vulva: clinical manifestations or mere coincidence?

Two hundred women with abnormal Pap smears and/or vulvar symptoms and 30 with normal Pap smears were investigated to determine the association between symptoms and (i) human papilloma virus infection of the vulva, and (ii) a spongiotic tissue reaction or a spongiotic dermatitis of the vulva. All had vulvar colposcopy and biopsy Human papilloma virus infection was diagnosed by histopathology and in situ hybridisation technique. HPV infection was present in biopsies of 48% of asymptomatic women and 33% with symptoms (p = 0.13) and HPV DNA in 37% of asymptomatic women and 31% with symptoms (p = 0.72). Spongiotic tissue reaction was diagnosed in 53.5% of asymptomatic women compared to 74% of symptomatic women (p = 0.007). This study suggests that vulvar symptoms are not clinical manifestations of HPV infection, but may be caused by dermatitis rather than HPV infection per se.

Adverse behavioral and sexual factors in chronic vulvar disease

OBJECTIVE

We investigated the prevalence of adverse sexual, personal hygiene, and self-treatment behavior among women with chronic benign vulvar and vaginal disorders.

STUDY DESIGN

This study was carried out by means of a scientific clinical audit producing actuarial data by way of a semistructured questionnaire. Subjects consisted of a sample of 530 cases treated at a specialist clinic for vulvar diseases. In addition to clinical and laboratory investigations, the patients were interviewed by the clinic's psychologist, who used a structured interview schedule developed specifically for the study. Descriptive analysis and analysis of variance were used to investigate data.

RESULTS

Most patients remained sexually active in spite of arousal failure and discomfort and engaged in unlubricated and often painful sexual intercourse. Most women engaged in potentially harmful genital hygiene and self-treatment behavior. Adverse self-treatment practices but not adverse genital hygiene practices were associated with greater symptom duration.

CONCLUSIONS

Adverse practices should be addressed during the management of cases of chronic vulvar disease.