Correspondence (letters to the editor): Some Additional Aspects

I wish to add to the interesting review article by Wölber et al. (1) that not only gynecologists but also dermatologists should be the primary medical specialists to consult for patients with vulvar pruritus, especially where the often difficult differential diagnostic evaluation of the different underlying causal dermatoses is concerned.

The stratum corneum of the vulvar epithelium—which can only be compared with facial skin— is the thinnest compared with all other anatomical locations of the human skin (2), which makes the vulva sensitive and prone to many different irritations and dermatoses.

Vulvar pruritis is often polyetiological. In addition to the—sometimes overlapping—dermatoses that were exhaustively explained in the article, the differential diagnosis may in some cases also be a somatoform disorder (3).

Intimate shaving—whether individually, religiously motivated or by fashion/zeitgeist—often leads to irritation of the vulva, with folliculitis, scaling/flaking, eczema, and subsequent pruritus; the same is true for the genital region in men. The authors’ important comment that the treatment of vulvar pruritus should be supported by refraining from intimate shaving surely also has relevance on a very different background. Individual rates of intimate shaving obviously correlate positively with the respective (asked for) number of sexually transmitted infections (4). Abstaining from intimate shaving can therefore also be an instrument of primary prevention of sexually transmitted diseases.