Do we know the frequency of genital psoriasis in the population, men and women?
Genital involvement (female and male) is common during psoriasis, affecting 46.5% of individuals during the course of their psoriasis.
We don’t really know the precise frequency of psoriasis of the vulva in the female population with psoriasis.
Vulvar psoriasis represents 2% of the reasons for consultation in vulvar pathology; it is also the third cause of consultation for vulvar involvement in the girl after eczema and lichen sclerosus.
Vulvar psoriasis is rarely isolated (2 to 5% of cases), but much more often associated with extra-genital psoriasis (70% of cases).
Description of genital psoriasis in women
Are there several forms of genital psoriasis in women? If yes, which ones?
Yes, there are several forms of vulvar psoriasis. The best-known form is so-called inverted psoriasis.
It reaches the folds of the root of the thighs by producing inflammatory cupboards (red), with clear borders, little or not at all squamous contrary to the patches of the skin which desquamate.
The absence of scales is related to the humidity of the folds. Other folds (sub-mammary folds, abdominal folds, navel) are very often affected too.
Psoriasis can also be present within the hairy areas of the vulva (pubis and labia majora).
It is very often itchy (itching) and chronic scratching nurtures psoriasis. Again, there is an inflammatory placard which extends to the entire pubis, with sharp edges or sometimes a smaller plaque on a large lip.
Psoriasis can finally be localized to the labia minora
Always in the form of a red plate, well limited. The vaginal mucosa itself is not affected by psoriasis. The diagnosis of this form is sometimes more delicate, requiring additional examinations, such as a mycological specimen or a vulvar biopsy.
How to treat women genital psoriasis?
Are the treatments the same for treating the vulva (upper part) or the mucous membranes (internal)?
The treatment of vulvar psoriasis is primarily of cortisone creams.
Cortizone 10 Ointment provides petrolatum-based service to offer an occlusive barrier to help save moisture in the clean areas of the skin.
It gives fast relief when you are tempted to scratch rashes, eczema, bug bites or psoriasis. Cortizone cream helps to reduce itchiness for comfort and healing.
It helps to relieve itching associated with minor skin inflammation, rashes from poison ivy, irritation, and insect bites.
- Inflammation and redness
- Skin irritation rashes
- Insect bites
- A well-rounded medicine cabinet
- Cortizone brings fast itch relief
Depending on the affected area, the dermatologist will prescribe more or less powerful dermo-corticosteroids.
Indeed, in the folds, the absorption of the dermo-corticoid is increased by the occlusion and the natural maceration and one will prefer dermo-corticoides of weak power with moderate.
In hairy areas, where the skin is thicker, strong or very strong dermo-corticoids will be proposed. As with other vulvar inflammatory diseases, such as lichen sclerosus, dermo-corticoids can be used prolonged with good local tolerance.
Treatments containing vitamin D may be offered in the form of gel on the hairy areas but they are irritating to the mucous membranes.
How to reduce pain caused by genital psoriasis in women?
The pain, often of the type of burns, is related to the presence of cracks or excoriations (abrasions) related to scratching within the psoriasis plaques.
Like itching, cortisone creams will relieve them. It is advisable to combine hydration of the mucosa with an emollient or a locally applied oil.
Whenever possible, avoid using ointments in any case for longer periods, as they cause maceration which may itself be responsible for irritation and therefore maintenance of psoriasis.
Are there any washing products (soap, syndet) that help reduce inflammation? The itching?
We must focus on everything that is not irritating: surgras soap, syndet, shower oil but it is primarily the topical corticosteroids that will reduce inflammation.
Roge Cavailles Extra-Mild Superfatted Soap 250g
Babies, children and older people use Roge Cavailles Extra Mild Superfatted soap. It enriches with almond oil to clean the skin carefully and softly. It has superfatted ingredients which leave a protective film on the skin. Use it daily to wash face and body for sensitive skin.
- Superfatted Ingredients
- It is used by older people, children and babies
- It enriches with almond oil
- It is ideal for daily cleaning of sensitive skin
- After the shower, after wiping, heat the folds with a hair dryer. The increase in temperature very gradually improves epidermal differentiation and has an anti-inflammatory effect. It is a treatment to follow indefinitely.
Similarly, there, as elsewhere, non-aggressive washing is useful for women, thanks to Saforelle products. But it is only the specific treatment that will control the itching.
Local corticosteroid therapy, in the form of lotion, by choosing a non-alcoholic lotion such as the Betneval lotion.
This treatment should be done every night for one month just before heating with a hair dryer, then the application can be spaced out gradually while maintaining a very prolonged weekly application. It is very effective against itching.
Women usually tolerate this treatment very well, which has no side effects.
What underwear can you wear (cotton …)? Should women with genital psoriasis avoid too tight pants, tights?
The friction, on the vulva as on the skin, can aggravate or maintain psoriasis by a Koebner phenomenon.
If we cannot stand tight pants, strings … then remove them, at least momentarily!
But no study proves that one must systematically get rid of it!
Is the attainment of the inter-gluteal fold automatic when one has a genital lesion? How to treat it?
Gluteal fold involvement is extremely common and often helps the dermatologist confirm the diagnosis of vulvar psoriasis. The treatment is the same as that of the vulva.
Appropriate advice and remarks
Can we use a female condom in full thrust of psoriasis?
There is no contraindication to this, as psoriasis has no impact on the vaginal lining.
Should we avoid the intercourse penetration during the period of inflammation?
Theoretically no, since there is no vaginitis (inflammation of the vagina) during psoriasis. But the penetration can be painful if there are cracks or very substantial inflammation.
Can psoriasis cause lubrication problems?
No. However, especially in cases of genital involvement, psoriasis impairs the quality of life and sexual well-being. It is possible that psoriasis has an effect on the libido, and that the lubrication becomes worse.
In periods of menstruation, should we prefer sanitary napkins or tampons?
Every woman will use what suits her best!
How to differentiate psoriasis from mycosis?
When the dermatologist has a diagnostic doubt between psoriasis and fungus (candidiasis or dermatophyte), he will ask for or practice a mycological sample. This is not a painful examination. It involves rubbing the skin or mucous membrane with a swab (a kind of cotton swab).
Can we also have both at the same time?
Yes, but it’s actually quite rare, especially for women.
Psoriasis and STI …
Some patients often worry as they often think confuse psoriasis with STI (Sexually Transmitted Infection).
What can we tell these patients?
It is important to tell them that, like on the skin, genital psoriasis is not contagious!
In women, the main differential diagnoses of vulvar psoriasis are not STDs or STIs, and this usually does not pose a problem for the dermatologist.
Psoriasis and libido: does psoriasis affect libido? What advice can we give?
Yes, genital psoriasis affects the quality of life, especially sexual life, which can then be responsible for psychological distress. It seems that it is more marked in women than in men.
The first tip to give them is to dare to talk about their genital psoriasis to their doctor and their dermatologist will take care of it.
If a relationship of trust is established between the practitioner and the patient, libido disorders can also be approached and defused.
The disappearance of cracks, excoriations related to scraping will allow to find a “local well-being” that will promote libido, lubrication and satisfactory sexual intercourse.
In any case, Psoriasis and Happiness can very well work together!
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