Treatment of Vulval Itching in Children

Diagnostic Approach

The Centers for Disease Control and Prevention recommends determining the underlying cause of vulval itching through clinical assessment and appropriate testing, as vulval itching can have multiple etiologies, with suspected vulvovaginal candidiasis (VVC) being diagnosed based on pruritus, erythema in the vulvovaginal area, and possibly white discharge with a normal vaginal pH (≤4.5) 1, 2
The American Academy of Pediatrics suggests considering bacterial vaginosis if there is vaginal discharge with a fishy odor, particularly after applying KOH, with a diagnosis confirmed by a vaginal swab 3

The Infectious Diseases Society of America recommends using clotrimazole 1% cream applied to the affected area 2 times daily for up to 7 days for a child with confirmed VVC, with the strength of evidence being moderate 1, 4
The Centers for Disease Control and Prevention advises against using oral fluconazole in children under 12 years old as safety data is limited, with the strength of evidence being high 1, 4

The British Association of Dermatologists recommends using topical steroids as the first-line treatment for lichen sclerosus, characterized by intense vulvar itching, with regular follow-up being essential as this condition requires monitoring 5

The Centers for Disease Control and Prevention suggests that self-medication with over-the-counter preparations should only be used if previously diagnosed with the same condition, with the strength of evidence being low 4
The American Academy of Pediatrics recommends that persistent symptoms require medical evaluation, especially if symptoms don't improve after initial treatment, with the strength of evidence being moderate 2

The Centers for Disease Control and Prevention recommends follow-up if symptoms persist or recur within 2 months, with the strength of evidence being low 4, 2

The normal vaginal pH is ≤4.5, according to the MMWR Recommendations and Reports 6
Evaluation should include assessment for signs of vulvar inflammation or discharge, vaginal pH, and presence of specific pathogens through appropriate testing when indicated, as recommended by the MMWR Recommendations and Reports 6

Implementing proper hygiene measures, including gentle cleansing of the vulvar area with warm water only, front-to-back wiping after toileting, avoidance of tight-fitting clothing and synthetic underwear, and wearing cotton underwear that is changed daily, is recommended by the MMWR Recommendations and Reports 6