Vulvar Psoriasis - Causes, Symptoms, and Treatments

Introduction

Human skin is a specific organ exposed to innumerable disorders and infections. Vulvar psoriasis is a specific skin disease in which psoriasis develops over the vulvar regions. It comes under the general category of genital psoriasis.

What Is Vulvar Psoriasis?

Vulvar psoriasis is a specific class of genital psoriasis that typically acts on the vulvar and related areas. Predominantly, it is encountered in patients with a psoriatic skin lesion somewhere in the body. However, it may occasionally develop independently. It can persist for longer, causing discomfort and annoyance. Vulvar psoriasis is not categorized as a sexually transmitted disease (STD). The site in which psoriasis develops makes it more uncomfortable and distressing. It can develop in any age group.

What Is Psoriasis?

Psoriasis is a widely known dermatological (skin) disorder that can develop anywhere on the skin. It can even involve the entire skin area, but frequently, it is encountered in specific areas of the body. When psoriatic rash extends into the genital areas, particularly affecting the private parts of the female body, they are known by the technical term genital psoriasis. When it develops over the vulvar region, it results in an awkward and embarrassing situation in which the person experiences extreme itching and soreness in the genital areas sparing the vagina. It does not spread to another person via direct sexual contact.

What Causes Vulvar Psoriasis?

Psoriasis develops due to abnormalities in the growth pattern of skin cells. The growth of each cell is strictly regulated and happens in a rhythmic pattern. This rhythm gets disturbed in psoriasis. As a result, skin cells grow and proliferate way faster than intended. Immune cells then wrongly recognize those cells as foreign material and elicit specific immune reactions to expel them. Eventually, it leads to the piling-up of skin cells, which form red-colored scaly skin patches, giving rise to psoriasis. It shows a cyclic pattern of exacerbation (active disease period) and stabilization (inactive disease period) throughout the disease course. It often projects familial influence in the development of the disease condition. A specific hypothesis suggests the presence of triggering factors that could precipitate psoriasis.

What Are the Symptoms Associated With Vulvar Psoriasis?

A red-colored rash with a silver scale is the hallmark feature of psoriasis. However, genital psoriasis does not exhibit typical findings, further complicating the diagnosis process. Scaly lesions cannot be identified in vulvar psoriasis. Frequently, it is encountered in the vulvar region. Apart from the vulva, other areas like the groin, labial folds, anus perineum, and inner thighs are also reported to be affected. Symptoms routinely associated with vulvar psoriasis involve the following:

• Erythematous (bright red).

• Pruritus (violent itching).

• Nonscaly in nature, unlike general psoriasis.

• The lesion appears symmetrical on either side of the body (bilateral symmetry).

• Innumerous red lesions, either flat or raised.

• Clearly defined rash borders.

• Penetrative sex evokes pain.

• No vaginal pain.

• Greyish plaques on the vulvar region.

• Soreness and stinging sensation.

• Skin ruptures and makes it susceptible to infections.

What Are the Different Forms of Psoriasis That Develop in the Vulvar Region?

Two specific forms of psoriasis tend to involve the vulvar and other genital areas.

1. Inverse psoriasis: Generally develops in areas of crease or folds. Sweat aggravates the itching and discomfort. The affected skin gives a characteristic smooth and shiny appearance.

2. Plaque psoriasis: Rarely develops in the vulvar region and is marked with greyish scales.

What Are the Risk Factors for the Development of Vulvar Psoriasis?

Certain factors could trigger the precipitation of psoriasis. Some potential risk factors include the following:

• Stress.

• Smoking.

• Unrestricted intake of alcoholic beverages.

• Extreme climates like the chillness or humidity.

• Infections.

• Few medicines.

• Obesity.

• Certain eatables.

• Abrasions in the skin.

How Is Vulvar Psoriasis Diagnosed?

• Diagnosing vulvar psoriasis is challenging and complicated as it has no specific test or procedure to detect the condition.

• In addition, Vulvar psoriasis lacks the typical psoriatic appearance, creating confusion in diagnosing the condition.

• A more significant proportion of the population who develop vulvar psoriasis is known as psoriasis patients with involvement elsewhere apart from the genital areas.

• Blood tests and cultures are advised to rule out suspected bacterial infections.

• Antifungal therapy on a trial basis helps clear off the lesion's fungal origin.

• Biopsy reflects light over the confirmation of diagnosis.

What Are the Treatment Interventions Available for Vulvar Psoriasis?

None of the currently available treatment interventions can completely cure psoriasis. However, effective treatment strategies are suggested that can provide symptomatic relief.

• Topical steroids: The most preferred treatment choice is mild steroids in the form of cream or gel. However, it is not advised as a long-standing therapy as it can create numerous health issues when used for a longer period.

• Topical vitamin D: Topical application of D vitamin in the form of creams (Calcipotriene) is reported to be effective against psoriasis.

• Calcineurin inhibitors: These medicines act by checking the immune response. Tacrolimus and Pimecrolimus are potent agents that suppress the immune system's activity.

• Coal tar cream: It helps to deal with itching and scratching sensations. It may sometimes evoke irritation in extremely sensitive skin; hence, it is not highly recommended.

• Antibiotic gel: Antibiotic gels like Dapsone are prescribed in order to check superinfections.

• Systemic medications: Certain immunosuppressive medicines are advised to be taken orally to control the symptoms. Methotrexate is the routinely proposed medicine among systemic drugs.

• Biologic agents: They are proteins that can potentially influence the body's defense mechanism. Biologics can be administered either via shots or intravenous infusion. Studies have concluded that biologics like Ixekizumab are exceptionally effective against vulvar psoriasis. In addition, they are reported to enhance the quality of life of psoriasis patients.

• Supplementary therapy: Supplementary therapy aims to manage the discomfort and, thereby, light up the quality of life. Supplementary therapy includes applying appropriate moisturizers, adhering to healthy dietary habits, and practicing relaxing techniques.

Conclusion

Vulvar psoriasis is a highly distressing and embarrassing condition in which itching and discomfort will be felt deep down in the vulvar area. Studies have demonstrated that more than 60 % of psoriasis patients develop these lesions in the genital area at some point in their life. Unfortunately, patients often consider it shameful and hesitate to report the itching and discomfort.