Genital rashes are common and many patients assume that they are associated with an STI, whereas they are often simply a dermatological condition.
Symptoms | Comments/Considerations |
---|---|
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 |
Diagnosis | Site/Specimen | Test |
---|---|---|
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 |
Principal Treatment Options | ||
---|---|---|
Diagnosis | Recommended | Alternative |
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 |
90% of patients with lichen sclerosus and lichen planus under regular review.