Itch? Or Burn?

[Guest guest]

Speaking of Itching? I too like Kay think that one of the biggest possibilities is lichen sclerosis.. that would be my first guess if it's been long term. Have you noticed architectural changes, or a whiteish/gray film in spots ? That's a sign as well, tho not always in the earlier phases. And not everyone with LS itches either but it is a very common symptom. Me I've never itched with a yeast infection either but WOW do I BURN.... so we are all different. LOL Just a thought. Here's a good article too that might help.

Dee

Itch or Burn? Clues to Treating Vulvar Skin Disease

Bruce JancinDenver Bureau

VAIL, COLO. — Asking whether a vulvar skin lesion itches or burns provides an early indication of how easy treatment is likely to be, Dr. Barbara R. said at a conference on obstetrics and gynecology sponsored by the University of Colorado. An itchy lesion that feels really good to scratch is probably going to respond easily to treatment. Patients who report this sort of symptom typically have a skin disorder featuring thickened skin, which releases a chemical that causes itching. This thickened skin stands up well to the rigors of treatment, explained Dr. , a dermatologist at the university. An example would be lichen simplex chronicus. Upon physical examination, this disorder is marked by lichenification, perhaps fissuring, and thickened skin. "Biopsy the involved skin to get the diagnosis. You are home free when you diagnose 'lichen simplex chronicus', because it's easy to treat," she said.

Treatment consists of using a potent topical steroid such as clobetasol for a couple of weeks, tapering down over the course of several more weeks to progressively lower-potency steroids. "If they're really itchy at night, start with only 10 mg of hydroxyzine.

(That's ATARAX, an oral prescription and one of my favs.. Dee)

I don't care what the size of the person is—people really differ in their response to oral antihistamines. If you start with 25 mg and they can't get up the next morning, they're never going to take another pill with that name on it," Dr. said. A far tougher therapeutic challenge is posed by vulvar disease that's itchy but doesn't feel better when scratched, or that itches and burns, or—toughest of all—mostly just burns. The burning is a symptom of skin that's open or abraded, even if only microscopically. And this means that topical steroids must be used with great care because of their epidermis-'thinning' effect. Indeed, potent topical steroids should be avoided altogether in patients with a burning vulvar skin lesion. Emollients and very gentle skin care—no scrubbing—are helpful. Burning vulvar dermatoses include allergic or irritant contact dermatitis, lichen planus, lichen sclerosus, Candida infection, desquamative inflammatory vaginitis, and pemphigus. Use of biopsies is a must in diagnosing vulvar skin disease. Biopsy the most erythematous area of involved skin; that's where the action is.

But ''don't'' biopsy ulcers or erosions—"You'll just get garbage," according to Dr. . Instead, biopsy the edges of ulcers or eroded areas. "You can use EMLA before a vulvar biopsy, but I usually don't find it necessary. I just numb them up. Usually, you find it's not terribly uncomfortable for the patient," she continued. It's important in treating vulvar skin disorders to adjust patient expectations at the outset. "I tell them skin takes 2 weeks to respond. It isn't going to respond overnight," Dr. said. Try to avoid the use of medicinal creams in the vulvar area.

Creams (and lotions) are complex products. They're water-based, so they invariably contain preservatives. Many also contain fragrances. These are common causes of irritation.

Ointments, in contrast, are quite simple. Often they consist only of petrolatum (aka vaseline) and the medication. This is the way to go in prescribing topical therapy in the vulvar area. Use low-potency topical steroids to treat vulvar psoriasis in order to avoid the tachyphylaxis and flares upon discontinuation that can occur with high-potency steroids in patients. Dr. said she "almost always" adds a topical antifungal ointment such as nystatin when treating vulvar psoriasis. Candida functions as a superantigen that causes psoriasis to flare.

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Comment* Note she did not mention Lichen Sclerosus which is really unfortunate (did lichen 'simplex' chronicus) where LS is not that easily dismissed or easily fixed but can be treated and live can be normal with maintenance) Dee