OB-GYN-L Messages for October, 2004: Re: vaginal itching

Re: vaginal itching

From:

Terrence.Jones@kp.org

Wed Oct 6 20:14:59 2004

Gary's got a good point --- if non-albicans yeast, then Triazole might be helpful (imidazole resistant). The culture may overcome the limitations of sensitivity of the wet smear for non-albicans spp (glabrata up here, tropicalis down in Your area); as these are less apt to sprout pseudohyphae (instead maintaining primarily 'bud' forms); yet continue to ferment causing contact dermatitis. Terazol (topical Triazole) may be another, or additional, locally active option (if resistant Yeast suspected). If Yeast is confirmed (by c/s or by therapeutic response), might consider eval for gycemic status and immunosupp. tj

garrys@mindspring.com (Garry E. Siegel, M.D.) Sent by: ob-gyn-l@obgyn.net 10/06/2004 05:36 PM Please respond to ob-gyn-l

To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> cc: Subject: Re: vaginal itching

Negative culture for yeast?

Empiric Diflucan 200 mg./weekly until asymptomatic, then every other week, and slowly taper.

Garry

At Wed, 6 Oct 2004, Terrence.Jones@kp.org wrote: >
>This is a multipart message in MIME format.
>--=_alternative 0071BC0388256F25 Content-Type: text/plain;
charset="us-ascii" >
>Desquamative inflammatory vaginitis (Sobel AJOG 11/94, 171:1215-20) -
>Intravag clinda. tj
>
>"Richard Chudacoff, MD" <rchudacoff@mylinuxisp.com>
>Sent by: ob-gyn-l@obgyn.net
>10/06/2004 12:39 PM
>Please respond to ob-gyn-l
>
> To: Multiple recipients of list OB-GYN-L
<ob-gyn-l@dns.obgyn.net> > cc:
> Subject: vaginal itching
>
>Patient with persistent vaginal/labial itching. Negative workup including
>monilia, BV, HSV, lichen sclerosis. Refractory to clobetasol,
fluconazole, >metronidazole. Only thing that works is Vagisil, but that is starting to
>decrease in efficacy too. Any suggestions?
>
>Richard Chudacoff, MD
>
>--=_alternative 0071BC0388256F25 Content-Type: text/html;
charset="us-ascii" >
> Desquamative inflammatory vaginitis
(Sobel AJOG 11/94, 171:1215-20) - Intravag clinda. tj > 
><table width0%>
><tr valign=top>
><td>
><td>"Richard Chudacoff, MD"
<rchudacoff@mylinuxisp.com> > Sent by: ob-gyn-l@obgyn.net
>10/06/2004 12:39 PM
> Please respond to ob-gyn-l
> 
><td> 
> To: Multiple recipients
of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > cc: 
> Subject: vaginal
itching</table> > 
> Patient with persistent vaginal/labial
itching. Negative workup including monilia, BV, HSV, lichen sclerosis. Refractory to clobetasol, fluconazole, metronidazole. Only thing that works is Vagisil, but that is starting to decrease in efficacy too. Any suggestions? > 
> Richard Chudacoff, MD
> 
> 
> 

-- Garry E. Siegel, M.D. Private Practice Roswell, GA

--=_alternative 00063B7A88256F26_ Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable

Gary's got a good point --- if non-albicans yeast, then Triazole might be helpful (imidazole resistant). The culture may overcome the limitations of sensitivity of the wet smear for non-albicans spp (glabrata up here, tropicalis down in Your area); as these are less apt to sprout pseudohyphae (instead maintaining primarily 'bud' forms); yet continue to ferment causing contact dermatitis. Terazol (topical Triazole) may be another, or additional, locally active option (if resistant Yeast suspected). If Yeast is confirmed (by c/s or by therapeutic response), might consider eval for gycemic status and immunosupp.   tj <table width0%> <tr valign=top> <td> <td>garrys@mindspring.com (Garry E. Siegel, M.D.) Sent by: ob-gyn-l@obgyn.net 10/06/2004 05:36 PM Please respond to ob-gyn-l <td>                To:        Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>         cc:                 Subject:        Re: vaginal itching</table> Negative culture for yeast? Empiric Diflucan 200 mg./weekly until asymptomatic, then every other week, and slowly taper. Garry At Wed, 6 Oct 2004, Terrence.Jones@kp.org wrote: > >This is a multipart message in MIME format. >--=_alternative 0071BC0388256F25 Content-Type: text/plain; charset="us-ascii" > >Desquamative inflammatory vaginitis (Sobel AJOG 11/94, 171:1215-20) - >Intravag clinda. tj > >"Richard Chudacoff, MD" <rchudacoff@mylinuxisp.com> >Sent by: ob-gyn-l@obgyn.net >10/06/2004 12:39 PM >Please respond to ob-gyn-l > >        To:     Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >        cc: >        Subject:        vaginal itching > >Patient with persistent vaginal/labial itching. Negative workup including >monilia, BV, HSV, lichen sclerosis. Refractory to clobetasol, fluconazole, >metronidazole. Only thing that works is Vagisil, but that is starting to >decrease in efficacy too. Any suggestions? > >Richard Chudacoff, MD > >--=_alternative 0071BC0388256F25 Content-Type: text/html; charset="us-ascii" > > Desquamative inflammatory vaginitis (Sobel AJOG 11/94, 171:1215-20) - Intravag clinda. tj > ><table width0%> ><tr valign=top> ><td> ><td>"Richard Chudacoff, MD" <rchudacoff@mylinuxisp.com> > Sent by: ob-gyn-l@obgyn.net >10/06/2004 12:39 PM > Please respond to ob-gyn-l > ><td> > To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> > cc: > Subject: vaginal itching</table> > > Patient with persistent vaginal/labial itching. Negative workup including monilia, BV, HSV, lichen sclerosis. Refractory to clobetasol, fluconazole, metronidazole. Only thing that works is Vagisil, but that is starting to decrease in efficacy too. Any suggestions? > > Richard Chudacoff, MD > > > -- Garry E. Siegel, M.D. Private Practice Roswell, GA

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