Vulval and scrotal pruritus
of the genital skin is usually caused by skin dis-ease, or by rubbing,
sweating, irritation or occlusion. Once started, genital itching seems able to
continue on its own.
vulva and scrotum contain nerves that normally transmit pleasurable sensations.
However, itching itself is not pleasurable, although scratching is. A torturing
itch may be present all day, but more frequently appears or worsens at night.
Once scratching has started, it per-petuates itself. The history is of an
incessant and embar-rassed scratching. Examination may show normal skin, or the
tell-tale signs of excoriations and lichenification.
is part of many inflammatory skin diseases. In the groin its most common causes
are tinea, candida, erythrasma, atopic dermatitis, psoriasis, pubic lice,
intertrigo and irritant or allergic contact dermatitis. However, patients with
‘essential’ pruritus show no skin changes other than those elicited by
scratching. Sometimes the cause is psychogenic, but one should be reluctant to
assume that this is the cause. Biopsy rarely helps. Look for clues by hunting
for skin dis-ease at other body sites.
potency topical corticosteroids sometimes help by suppressing secondary
inflammation; however, atrophy sometimes quickly occurs, and then the itch is
replaced by a burning sensation. A better approach is to eliminate the trigger
factors for itchasuch as hot baths, tight clothing, rough fabrics, sweating,
cool air, the chronic wetness of vaginal secretions, menstrual pads and soaps.
Antipruritic creams, such as doxepin cream, pramoxine cream or menthol in a
light emol-lient base, help to abort the itch–scratch–itch cycles. Many
patients benefit from systemic antihistamines or tricyclic drugs such as
amitriptyline or doxepin.
is common but hard to see. Lichenification creates leathery thickenings, marked
with grooves resembling fissures.