Desquamative Vaginitis—How to Recognize and Treat It
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the typical symptoms of desquamative inflammatory vaginitis 2. List the typical treatment options and duration of therapy
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from April 10 2018 through 07/15/2022, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Desquamative inflammatory vaginitis is a form of vaginitis occurring primarily in perimenopausal white women. The etiology is unknown. The syndrome includes vaginal inflammation, rash and purulent discharge along with dyspareunia.
Consider desquamative vaginitis in women presenting with
Chronic vaginal symptoms, specifically
Discharge | pruritis |burning| irritation
Exam findings may include
Vaginal inflammation (‘fiery red’)
Spotted vaginal rash
Areas of a white reticulated pattern
Erosions in a spotted or linear pattern
Areas of hemorrhage or ecchymosis
Lack of Lactobacillus predominance
Vaginal pH is typically ≥5
Microscopy shows increased parabasal cells and inflammatory cells (neutrophils)
Inflammatory to squamous cell ratio is 1:1
Rule out trichomoniasis
WBCs my be present with similar pH
However, parabasal cells less likely to be present and motile T. vaginalis organisms can be seen on microscopy
Look for oral, cutaneous or vulvovaginal lesions that may be suggestive of lichen planus
Desquamative inflammatory vaginitis should be in the differential diagnosis for all menopausal and perimenopausal women presenting with complaints of chronic vaginitis. It is important to rule out other entities such as BV, trichomonas, and STDs prior to beginning treatment. Treatment is generally of longer duration than for other causes of vaginitis. Cause is unknown, with disproved theories including estrogen deficiency, bacterial infection, or vitamin D deficiency. Possible underlying mechanisms include a noninfectious disease with a genetic predisposition for an abnormal immune attack on elements in the vaginal mucosa.
Treatment is topical and can be either antibiotic or steroid based (official guidance on treatment not yet developed)
Clindamycin 2% cream: Intravaginally once daily (bedtime) for 1-3 weeks; Consider maintenance once or twice a week for 2 to 6 months or
10% hydrocortisone cream 300-500 mg: Intravaginally daily (bedtime) for 3 weeks; Consider maintenance once or twice a week for 2 to 6 months or
Cortisone acetate 25 mg suppository: Twice daily for 4-6 weeks or
Clobetasol propionate: Intravaginally daily (bedtime) for 1 week; Maintenance duration not evidence-based
Consider addition of Fluconazole 150 mg orally once a week as maintenance therapy or topical vaginal estrogen twice a week in addition to clindamycin or glucocorticoid
Reevaluate 4 weeks after treatment is concluded and if residual symptoms persist and clinical findings are only partially controlled, offer additional treatment such as
Reverse treatment—if initially on clindamycin, switch to hydrocortisone and vice versa
Combine treatment—use both clindamycin and hydrocortisone together
Increase hydrocortisone to 15% strength cream
Cure rates are low
26% cure at 1 year
58% will be controlled (require maintenance therapy)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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