Sunshine Clinic
The Private Health Clinic
Genital Skin Conditions
What are Genital Skin Conditions
Behcet's Disease or Syndrome
A syndrome is a group of symptoms, which is a term doctors use rather than disease when the cause linking the different features is not known. The cause of Behcet's syndrome is unknown, but it causes the skin to become inflamed, and this can happen in many different parts of the body, especially the genital area. Behcet's syndrome is an autoimmune condition in which the body's own system attacks the body's tissues, causing ulcers in the mouth and genital area. It can also cause red eyes, painful skin lesions, and joint pains. It can not be passed on to other people. Behcet's syndrome occurs in men and women of all age groups, although usually develops in the 20's and 30's. It is a long term problem which sometimes becomes less active in later life.
Lichen Sclerosus & Lichen Planus
Lichen sclerosus is similar to lichen planus, which are both sometimes associated with autoimmune disease, and thyroid disorder.
Lichen sclerosus can affect all areas of the body, especially the genital area in women where thickening of the skin of the vulva can occur, and may also cause thickening of the foreskin in men. Itching is common in both conditions, and sexual intercourse can be painful.
Lichen Planus is an uncommon skin condition, it is thought to be due to an abnormal immune reaction. This can be provoked by a viral infection or in some instances by a drug. Lichen Planus can affect any area of the body and in 85% of cases it clears from the skin surface within 18 months, although it may persist longer, especially in areas affecting the mouth or genitals.
Psoriasis & Genital Eczema
These are skin conditions involving the genital area, which can both cause the genital area to be itchy.
Psoriasis causes red raised plaques, and it is a common long term condition that affects people of all ages, estimated to be 2% of the population. The most common ages that this condition first appears are those in their late teens, and then the late 50's. It affects men and women equally, although in children, girls are more commonly affected than boys. Psoriasis tends to run in families, and it can also be influenced by many environmental factors. It is not contagious and is not due to an allergy.
Genital Eczema, (Eczema dermatitis) primarily involves an inflammatory process, which may be due to a complex interaction of either genetic or environmental factors. Eczema can affect all age groups, and is not contagious. Eczema can affect many different areas of the body including the genital area, in particular the vulval area, where it appears as scaly and moist erythema. Erythema is the initial reaction in the skin when there is an increased blood supply to the affected part of the skin, followed by redness, blisters, sometimes rupture or weeping. This could happen as a reaction to a chemical, for example, washing powder, watch strap, bacteria, and some ingested foods or drugs.
Scabies & Pubic Lice
Scabies and pubic lice are skin infestations with mites and lice, which can cause intense itching in the genital area. Pubic lice are tiny parasitic insects that live in coarse body hair, such as pubic hair. They are yellow-grey and about 2mm long. They have a crab-like appearance, so they are often known as 'crabs'. It can take several weeks after coming into contact with pubic lice before the signs and symptoms of pubic lice appear. Nits are the eggs which appear as brownish dots fixed to the hair. Pubic lice are easily passed from one person to another through close body contact or sexual contact. Both men and women can get pubic lice, and pass them on. Pubic lice are different to head lice.
Scabies is caused by a mite (Sarcoptes scabiei) which burrows under the skin, but the rash and itch are much more widespread than the location of the mites. The mite burrows into the skin, especially around the hands, feet, and male genitalia. The itching is due to an allergic reaction to the tiny mites, and is associated with a rash of red, raised spots. The itch is worse at night, and may often affect more than one family member. Unless you develop symptoms you may not know whether you or your partner has scabies and it can take up to six weeks after coming into contact with scabies before signs and symptoms may appear.
Diagnosis
Behcet's Disease or Syndrome
The main symptoms of Behcet's syndrome are ulcers either in the vagina or on the vulva in women, and may also occur around the anus and in the groin. In men and boys ulcers can affect the scrotum or the penis, they can also experience pain and swelling of the testicles. A number of different skin problems may occur on the body, for example, redness, inflammation, lumps under or in the skin. People with Behcet's syndrome tend to have skin which easily becomes inflamed or ulcerated or appears to be infected. Symptoms can also occur in the mouth, eyes, and joints. A large number of people with this condition (about 98%) suffer recurrent mouth ulcers. Problems associated with Behcet's may also effect the nervous system, causing headaches and occasionally other symptoms like double vision, difficulty hearing, giddiness, loss of balance, and some suffer depression or other psychological difficulties. Behcet's syndrome may also cause bowel
problems such as bloating, or inflamed bowels, which may lead to diarrhoea and abdominal pain. Blood vessels, particularly small blood vessels, can become inflamed.
Lichen Sclerosus & Lichen Planus
Lichen sclerosus is recognised in women by white thickening of the skin of the vulva. It can be localised to one small area, or involve almost all the genital area including the clitoris, and in some cases the clitoris disappears. There can also be shrinking of the skin involving tightening to the entrance of the vagina. Lichen sclerosus never affects inside the vagina. The skin can be unbearably itchy causing blood blisters and ulcers after scratching. Sexual intercourse can be uncomfortable and may result in splitting the skin. Particular care is needed if a slow growing lump or sore doesn't heal. Vulval lichen sclerosus has also been associated with genital warts.
Lichen Planus may cause painless white streaks, erosive lichen planus is more common and is one cause of vulvodynia, which can cause burning and discomfort of the vulva. Erosive Lichen Planus can affect many different parts of the genital area, including the entrance to the vagina which can make sexual intercourse very painful, sometimes preventing intercourse and in some cases
scaring or closing over the vagina.
Psoriasis & Genital Eczema
Psoriasis is characterised by red, scaly patches of skin, which usually have well defined edges. The scale is typically silvery white. Psoriasis is often minor, causing a few dry patches on the backs of the elbows and knees, some irritation in the belly button, or scaling of the scalp, although it can however, affect any area of skin and it may be severe. Chronic or long-term plaque psoriasis are large flat patches covered in scale, most often on the elbows, knees and back.
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Flexural psoriasis: smooth well-defined patches in the body folds
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Scalp psoriasis: one or more scaly plaques in the scalp
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Acute guttate psoriasis: numerous and often widespread small patches
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Sebopsoraisis: overlap of seborrhoeic dermatitis and psoriasis, affecting scalp, face, ears and chest
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Palmoplantar psoriasis: several patterns of psoriasis on the palms of the hands and soles of the feet
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Nail psoriasis: pitting, onycholysis, yellowing and ridging
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Koebnerised psoriasis: psoriasis arising in healing wounds or scars
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Photosensitive psoriasis: psoriasis affecting sun-exposed skin
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Erythodermic psoriasis: severe psoriasis affecting the entire skin surface
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Psoriatic arthritis: joint disease related to psoriasis
The exact cause of psoriasis is not fully understood but the following factors have been linked to the condition:
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genetic influences
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stress
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infection
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injury
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hormones
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medications
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ultraviolet light
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alcohol and smoking
There is to date no cure for psoriasis, but satisfactory control of the disease is possible for most people.
As in all skin conditions, particularly in vulval conditions like vulval eczema, a good history about the nature of the condition is important, plus a methodical clinical examination. Clinical features of genital eczema are:
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vulval itching
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soreness
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erythema
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lichenification (thickening and hardening of skin)
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fissuring (cracking and splitting of skin)
There may be signs of other infections such as thrush, a fungal infection.
Scabies & Pubic Lice
Diagnosis is by clinical examination. Occasionally it is possible to isolate mites and lice and see them by microscopy.
Treatment
Behcet's Disease or Syndrome
Blood tests are needed to rule out other diseases that can be confused with Behcet's syndrome. Several drugs used for Behcet's syndrome need regular bloods tests to make sure they are having beneficial effects, and to check that side-effects are not happening. At present there is no cure for Bahcet's syndrome, but treatment can control the severity and frequency of the symptoms. Treating the ulcers may involve a spray applied directly to the ulcers, or oral medication may be used depending on the seriousness of the problem. The Doctor will match the strength of medication required for each problem. The disease tends to go through phases in which it is better or worse, so ongoing regular reviews are recommended with a specialist Doctor.
Lichen Sclerosus & Lichen Planus
Treatment for Lichen sclerosus usually involves blood tests, to identify if there are any changes in the autoimmune system, and thyroid function tests. Depending on the severity of the condition medication may involve either oral or topical applications. Occasionally treatment may involve a biopsy if the condition does not respond to treatment.
Treatment for Lichen Planus is not always necessary, for people who need treatment ultra-potent topical steroids are sometimes
prescribed for periods of four to six weeks. Other treatments that may be used, by injection or oral medication:
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long term antibiotics
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anti-fungal agents
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photo-therapy
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immune modulating drugs
Occasionally a biopsy may be taken to confirm diagnosis and treatment.
Psoriasis & Genital Eczema
Treatment for psoriasis involves the use of steroid creams, plus a vitamin A and tar preparation. Some people may have a single episode of psoriasis that clears after a few months and never recurs. Most other forms of psoriasis run a fluctuating course with periods of improvement, or clearance, only to relapse at a later time. Some treatments and preparations used for psoriasis on other parts of the skin, are too irritant to be used on the vulva. Occasionally patch testing is necessary if an adverse effect of local applications is suspected, it is important that a qualified dermatologist treats this disease.
A consultation and clinical examination with a specialist in vulval conditions is needed for appropriate diagnosis and treatment of vulval eczema. Treatment for eczema nearly always requires reduction of exposure to trigger factors, for example care should be given to skin exposed to various irritants and allergies. Treatments include:
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regular emollients (moisturisers)
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intermittent topical steroids, as a cream or ointment
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sometimes the use of antibiotics, antihistamines, or oral corticosteroids
Scabies & Pubic Lice
Treatment is by Permethrin and Malathion lotion. The treatment kills the mites, but as the bodies are still in the skin and it is the bodies that cause allergic reaction, the itch persists until our own natural defence systems break down and get rid of what is left of the mites. This process takes about two weeks and therefore the itch continues for about two weeks after the treatment.
Clothing, bedding and towels should be washed on a very hot cycle (greater than 50°C) to avoid re-infection.
I May Have a Genital Skin Condition
If you have any concerns relating to this condition, or any conditions described on this website, please contact the Sunshine Clinic by telephone to arrange an appointment with Dr Sood, on 0845 505 0552