Guideline sources The following summarized guidelines for the evaluation and management of vulvar dermatitis are prepared by our editorial team based on guidelines from the European Academy of Dermatology and Venereology (EADV 2017). 1 Guidelines 1. Diagnostic investigations Patch testing: obtain patch testing in patients with suspected allergic contact dermatitis. B 2. Diagnostic procedures Biopsy: perform biopsy in patients with atypical features or failing to respond to treatment. B 3. Medical management Topical corticosteroids: Consider offering a topical corticosteroid in patients with vulvar dermatitis, such as: hydrocortisone 1% ointment for mild cases mometasone furoate or betamethasone valerate 0.025% ointment for severe cases. C https://web.pathway.md/diseases/recDNWwplgekF0cQc 1/2 6/29/23, 3:44 AM Vulvar dermatitis Pathway Apply topical corticosteroids once daily for 7-10 days until the symptoms and signs settle, and then as needed for any recurrent symptoms. B Antihistamines: consider offering a sedating antihistamine at night to reduce the damage inflicted by scratching. Calcineurin inhibitors: consider offering calcineurin inhibitors, such as topical tacrolimus and pimecrolimus, in patients with resistant vulvar dermatitis. Recognize that their use is limited by stinging on application. C Management of co-occurring infections: administer a combination of corticosteroids with antibiotics or antifungals for the treatment of any coexisting infection in patients with vulvar dermatitis. B 4. Nonpharmacologic interventions Avoidance of irritants and allergens: advise avoiding irritants and possible allergens, such as cleansers, fragrances and wet wipes in patients with vulvar dermatitis. B Emollients: advise using bland emollients, such as emulsifying ointments as soap substitutes in patients with vulvar dermatitis. B 5. Follow-up and surveillance Indications for referral: refer patients with urinary incontinence for urological and gynecological investigations. References 1. van der Meijden WI, Boffa MJ, Ter Harmsel WA et al. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2017 Jun;31 6 925 941. Open https://web.pathway.md/diseases/recDNWwplgekF0cQc 2/2