Skin rash - genital
Genital rashes are common and many patients assume that they are associated with an STI, whereas they are often simply a dermatological condition.
|Itch||Associated with the need to scratch|
|Burning, dysaesthesia||Unpleasant sensation not associated with an irresistible need to scratch|
|Colour change in skin||Red, white or haemorrhagic patches|
|Change in texture of skin||Thickened or thin areas of skin in normal skin background|
|Candida||Vulva swab, high vaginal swab or self-collected vaginal swab||Microscopy, gram stain and culture|
|Lichen simplex, planus or sclerosus||Vulva||Biopsy|
|Dermatitis or psoriasis||Vulva||Biopsy|
|Pruritis ani||Perianal swab||Swab for culture|
- Skin biopsy for candida where swabs are negative and erythema with splitting is present.
- Biopsy area of skin with worst appearance or take multiple biopsies if areas look markedly different.
Specimen collectionClinician collected | Self-collection
- Infection with uncommon species of candida may require sensitivity testing.
- Always confirm recurrent candida with repeat testing as not all itch is candida.
- Re-biopsy if an unusual area appears after successful treatment.
|Principal Treatment Options|
|Candida - simple vaginal||Vaginal azole creams (eg. clotrimazole 10% vaginal cream, 1 applicatorful intravaginally at night, as stat dose or 3-7 days course)||Fluconazole 150mg PO, stat|
|Candida - recurrent or chronic vaginal||Treat each episode with longer course of azole cream (rather than stat dose) and/or induction with fluconazole 150mg PO, for 3 doses, 3 days apart, followed by maintenance with fluconazole 100mg PO, weekly for 6 months||Itraconazole 100mg PO, daily until asymptomatic then 100mg weekly for 6 months|
|Candida - vulval skin||At least 21 days of topical azole cream, TDS||May require longer treatment|
|Lichen simplex||Daily topical mid strength corticosteroid ointment||Oral antihistamines may help to break the itch-scratch-itch cycle|
|Lichen planus||Daily high strength topical corticosteroid ointment||May require specialist review|
|Lichen sclerosus||Daily high strength topical corticosteroid ointment||May require specialist review|
|Dermatitis||Daily topical mid strength corticosteroid ointment||Cream if weeping skin|
|Psoriasis||Daily topical mid strength corticosteroid ointment||Coal tar and emollients
|Pruritis ani||Daily mild topical corticosteroid ointment||Oral antihistamines may help to break the itch-scratch-itch cycle|
- Infection with uncommon species of candida may require specialist review
- Treat until symptoms and signs have resolved
- Lichen planus and lichen sclerosus require long term maintenance topical steroid and regular review. Commencing these treatments without biopsy confirmed diagnosis is not recommended
- Dermatitis and psoriasis may require long term maintenance or may be treated intermittently
- Ointment is most useful for dry skin and cream for wet, weeping skin
- Creams have preservatives that may cause irritation. Consider this as a cause if not responding.
Other immediate management
- Avoid soap, perfumed products, bleaches and other irritants or allergens
- Ensure skin hygiene is maintained with cool water and a soft cloth but avoid over-cleaning
- Wear loose cotton clothing and avoid overheating
- Burow’s solution (13% aluminium acetate) diluted 1:20-1:40 with cold water applied as a cold compress BD may be helpful for burning itchy skin
- Use daily sorbolene for moisturising skin.
- Follow up one month after commencement of treatment
- Reduce regularity of treatment application after symptoms or signs have resolved
- Review patients with lichen planus or lichen sclerosus at least annually once stable.
90% of patients with lichen sclerosus and lichen planus under regular review.
- Russell D, Bradford D and Fairley C. Sexual Health Medicine. 2nd edition. IP Communications. 2011