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Diabetic vulvitis - Anogenital in
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Diabetic vulvitis - Anogenital in

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Contributors: Mitchell Linder MD, Misha Miller MD, Whitney A. High MD, JD, MEng
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Synopsis

Diabetic vulvitis is inflammation of the vulva caused most often by overgrowth of the yeast Candida albicans in the setting of diabetes mellitus. Diabetes predisposes to vulvitis both through general immune dysfunction and because of elevation of blood glucose, which allows for overgrowth of some commensals, including yeast.

Candida is a part of the normal vulvovaginal flora in approximately one-fourth of all women. C albicans is a budding yeast that is a common inhabitant of the vagina. It does not normally cause disease unless the microenvironment of the vagina is somehow altered, allowing overgrowth of C albicans. Nearly three-fourths of all women experience candidal vulvitis in their lifetime, and approximately one-half of these women have multiple episodes. Diabetic individuals, in particular, are predisposed to recurrent disease.

Diabetic vulvitis is characterized by itching, burning, and odor. Dyspareunia and pain upon urination may be reported as well.

Related topics: Diabetes mellitus type 1, Diabetes mellitus type 2, Vulvovaginal candidiasis

Codes

ICD10CM:
N76.89 – Other specified inflammation of vagina and vulva

SNOMEDCT:
198217000 – Vulvitis associated with another disorder

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis of diabetic vulvitis includes the following:
  • Contact dermatitis – either irritant or allergic contact dermatitis may be observed and is related to the use of personal hygiene products, spermicides, or other contactants upon the skin.
  • Inverse psoriasis – the patient is more inclined to have additional evidence of psoriasis on the skin or in the nails. A family history is present in one-third of cases of psoriasis, and the condition would not be associated with visible yeast overgrowth visualized on a KOH wet preparation.
  • Bacterial vaginitis – produces visible "clue cells" on a KOH wet preparation with a positive amine smell ("whiff test").
  • Trichomoniasis – produces visible trichomonad organisms on a KOH wet preparation.
  • Lichen planus – a condition associated with intense pruritus and sometimes painful erosion and ulceration. The condition is not specifically associated with diabetes and often involves the oral mucosa as well. Wickham's striae are white lacy plaques seen in mucosal lichen planus.
  • Lichen sclerosus – a chronic condition causing atrophic pruritic or painful plaques on the vulva and perianal area. The lesion results in fragile porcelain-white skin that often has associated purpura, fissuring, and skin breakdown.
  • Vulvovaginal atrophy – a condition associated with decreased estrogen production during the peri- and postmenopausal years. Patients may complain of dryness, skin cracking, spotting, and/or pain with intercourse.

Best Tests

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Therapy

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References

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Last Reviewed: 10/05/2018
Last Updated: 10/17/2018
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Diabetic vulvitis - Anogenital in
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Diabetic vulvitis : Labia majora, Labia minora/vestibule, Recurring episodes or relapses, Vaginal opening, Vaginal-labial burning, Vaginal-labial itching, thick white curd-like vaginal discharge
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