Vulvar Pruritus in Postmenopausal Diabetic Women With Candidiasis Secondary to Sodium-Glucose Cotransporter Receptor-2 Inhibitors.

We present a case series of recurrent vulvovaginal candidiasis (RVVC) secondary to sodium-glucose cotransporter receptor-2 (SGLT2) inhibitor-induced glucosuria in postmenopausal women that resulted in extensive vulvar skin involvement. We describe 5 cases of RVVC presenting primarily with vulvar pruritus and external rash, in type 2 diabetic, postmenopausal women on SGLT2 inhibitor therapy. This work was exempt from institutional review board approval in compliance with the university guidelines for determining human subject research. All patients consented to the use of pictures for educational and research purposes. All patients developed RVVC, with vulvar cultures positive for Candida albicans and resolution of symptoms after treatment with oral fluconazole. All patients presented primarily with severe vulvar pruritus that developed after beginning treatment with SGLT2 inhibitors (range: 4 wk­16 mo). Given the intermittent nature of symptoms, variable degree of activity at presentation, lack of vaginal discharge, atypical population, and extensive skin involvement, RVVC was not considered initially. Three patients were misdiagnosed with lichen sclerosus and treated with topical steroids, which may have allowed for disease progression. Two patients were prescribed topical estrogen creams for presumed vaginal atrophy. One patient was misdiagnosed with improper vulvar hygiene and neuropathic itch. Because of these diagnostic missteps, 4 patients endured symptomatically for extended periods (range: 2­6 years) without adequate treatment. Four patients have discontinued their SGLT2 inhibitor, all with resolution of vulvar symptoms. Postmenopausal, diabetic women taking SGLT2 inhibitors presenting with vulvar pruritus and rash require early evaluation for RVVC to prevent misdiagnoses and need for diabetic medication alterations.

Resolution of Treatment-Refractory Prurigo Nodularis With Dupilumab: A Case Series.

Prurigo nodularis is a pruritic skin condition that can present therapeutic challenges. We present a series of three patients diagnosed with prurigo nodularis who had failed several commonly trialed therapies, but experienced relief from symptoms and improvement in skin lesions following initiation of dupilumab therapy. All patients in this series lacked a diagnosis of atopic dermatitis and had lesions on the lower extremities, although other locations such as the trunk were also involved. Continued study of dupilumab in patients with prurigo nodularis is advocated.

Trigeminal trophic syndrome with histopathologic correlation.

We present the case of a 49-year-old woman with trigeminal trophic syndrome (TTS), also known as trophic trigeminal neuralgia, trigeminal neurotrophic ulceration, and/or trigeminal neuropathy with nasal ulceration. Our case represents an uncommon report of intractable itching and chronic pain associated with TTS. Emphasis was placed on skin biopsy histology, which revealed no neuronal innervation of the affected scalp despite reports of intractable itching and chronic pain. Trigeminal trophic syndrome of the V1 branch of the trigeminal nerve secondary to herpes zoster (HZ) with correlated histology is described. This article provides a discussion of TTS and correlated histology as well as a brief discussion of intractable itching and postherpetic neuralgia.

Vulvar dermatitis from allergy to moist flushable wipes.

Methylchloroisothiazolinone/methylisothiazolinone is a preservative found in cosmetic and industrial products, and is a common ingredient in moist toilet paper. It is a well-known allergen and is capable of causing allergic contact dermatitis.We present the case of a 58-year-old white woman with a cutaneous vulvar eruption with associated discomfort and pruritus of 6 months in duration. She had been treated with antibiotic and antifungal agents without improvement of symptoms. Careful history taking revealed that the patient was using moist toilet paper. Patch testing confirmed an allergy to methylchloroisothiazolinone, a preservative in the moist toilet paper. After discontinuation of the product and treatment with potent topical steroids, the eruption completely cleared.With the growing use of moist toilet paper among adults, the risk of exposure and potential sensitization is increasing. Health care providers should be aware of the risks of moist toilet paper containing potential allergens because perianal and perineal dermatitis caused by these products may be unrecognized or misdiagnosed. After proper treatment, patients must be educated about alternatives and the importance of label reading.