Background: Vulvar pruritus is a common complaint in females of all ages. However, little has been published on pruritus vulvae in children as a primary symptom. Objective: Our purpose is to review the causes and treatments of vulvar pruritus in prepubertal girls and to retrospectively evaluate the causes and outcomes of the premenarchal children we studied. Methods: The records of 44 premenarchal girls with vulvar pruritus were reviewed, and follow-up interviews were performed by telephone. Results: Thirty-three patients (75%) had nonspecific pruritus. Lichen sclerosus, bacterial infections, yeast infection, and pinworm infestation were seen in a minority of patients. At follow-up, pruritus had cleared in 15 patients, been alleviated in 13, and remained the same in 4. Conclusion: Most of our patients had nonspecific pruritus, which was alleviated by or cleared with better hygiene and avoidance of irritants. In prepubertal girls, poor hygiene and irritants such as soap are major contributors to pruritus vulvae. All patients may benefit from following hygienic measures and irritant precautions in addition to specific therapy directed at underlying causes. (J Am Acad Dermatol 2001;44:795-802.)