Understanding & Managing Vulvar Eczema

Eczema is a non-infectious inflammatory skin condition resulting in red, dry, itchy skin. It can happen anywhere on the body, including the external genital skin, such as the labia.

You can’t get eczema inside your vagina, because the type of skin cells that ‘get’ eczema do not exist inside the vagina. You can, however, get eczema that spreads up into the buttocks and around the anal area.

There are several different types of eczema that can impact the vaginal and anal area:

Atopic eczema
Seborrheic dermatitis
Allergic contact dermatitis
Irritant contact dermatitis

Diagnosis of vulvar eczema

Diagnosis of any sort of dermatitis should be performed by a doctor or dermatologist. There are some investigations that should be carried out to eliminate other causes of the symptoms, such as a yeast or bacterial infection, sexually transmitted infections, or dryness caused by low oestrogen (such as in menopause).

Symptoms of vulvar eczema

Itching, usually on the outer labia (labia majora) where pubic hair grows
Thickened skin

Causes of vulvar eczema

Sweating
Tight clothes
Stress
Local irritant like soap, toilet paper, detergent, pads, panty liners, perfumes, shower gel, talcum powder, wipes
Haemorrhoid treatments
Antiseptics
Vaginal discharge
Immune reaction to food (gluten, dairy)
Urine or faeces coming into contact with vulva skin
Piercings or tattoos with allergenic ingredients (nickel allergy)
Spermicides, condoms, lubricants

Treatments for vulvar eczema

Soothing vagina and vulva-safe creams can work very well to soothe mild eczema, as can oat baths and soothing, protective ointments. Emollient creams can be applied as often as need, and reapplied after baths, showers or swimming.

Special soap substitutes may be advisable, and ensuring good hygiene after bowel movements to avoid infection of very irritated, inflamed skin. If dryness is caused by menopause, Fennelope or EstroBoost are useful as soothing, repairing treatments without steroids.

Cortisone cream is the usual medical treatment for eczema. But, steroid treatments destroy skin over time, causing thinning with overuse, so speak with your doctor about usage limits. If using both an emollient and steroid, separate the application by about 20-30 minutes to avoid diluting the steroid. It doesn’t matter which you apply first. Use steroids as far away from sex as possible to avoid treating your partner with steroids also.

Avoiding irritants is an important first step, and eliminating the primary suspects (laundry detergent, soaps, etc.).

Another avenue is to do a thorough assessment for irritants and allergens that are being consumed, or that are in the environment – a less straightforward task.

It’s advisable to get help from a naturopath or specialised dietician/nutritionist to review your diet, do allergy or intolerance testing where required, and guide you through figuring out what’s going wrong.

You can start off at home by yourself with a couple of simple foods. Avoid some common and well-known eczema triggers, such as dairy products and wheat.

Avoid these strictly for six weeks, then reintroduce one at a time to see what happens, allowing a few days to a week for a reaction to occur. It can pay to get help with elimination diets since they can be challenging to do without guidance.

How to manage severe itching

If itching is severe, the urge to scratch can be unbearable. Once you do scratch, something called the ‘itch-scratch cycle’ can occur, making the itching worse, which you scratch, which then makes the itching worse again. Oatmeal baths can soothe itching. Avoid the urge to scratch as much as possible, and use icepacks, oat baths and anything you can to avoid scratching.

Scratching breaks down the barrier of the skin even further, worsening symptoms and creating an unprotected environment for infections and soreness.

Keep your creams and emollients in the fridge so when you use them, they are cool and a little more soothing.

Sometimes there are other causes of itching, such as iron deficiency anaemia, yeast infections, and other infections – see your doctor for a test. Itching during the night/sleep can be helped by antihistamine preparations by your doctor or naturopath/herbalist.

How to keep the vulva clean with eczema

While keeping clean and dry is important, over-washing can worsen genital eczema by removing the protective oily barrier. Wash your vulva with warm water and an emollient soap substitute.

Skip regular soap, antiseptic washes, wet wipes of any kind (except a brand called Water Wipes), bubble bath, genital deodorants, fragrances of any kind and powder. If you have a bath, wash your hair separately to avoid the shampoo – which often contains skin irritants like sodium laurel sulphate (SLS) – from touching your vulva. If the bath is your only option for washing your hair, apply the emollient to your vulva first.

Wash your hands after apply any cream or steroids.

Hair removal with vulva eczema

Waxing and shaving may irritate skin even further, so be judicious in what sort of hair removal – if any – you choose to employ. Laser hair removal may not be an option unless you are symptom-free at the time.

Use emollient as shaving cream instead of soap or shaving foam.

How to dress when you have genital eczema

Loose fitting natural fibres may be the most comfortable, while tight, synthetic materials less so. Underwear made from bamboo, cotton or silk are most comfortable.

How to wash clothes with genital dermatitis

Choose non-biological laundry detergents where you can, though these typically require higher temperatures to effectively clean clothes of grease (especially your emollients). Rinse clothes well. Avoid fabric softeners, as they leave residue on clothing. Avoid anything with fragrance.

References^1,2

1.
Jadhav A, Mundhe A, Deo K, Deora M, Gaikwad R, Shinde R. Prevalence and risk factors of vulvar dermatoses: A hospital-based study. Indian J Sex Transm Dis. Published online 2022:30. doi:10.4103/ijstd.ijstd_108_21
2.
National Eczema Society (NES). Female genital eczema. National Eczema Society. https://eczema.org/information-and-advice/types-of-eczema/female-genital-eczema/