Genital dermatology
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- Many non-sexually transmitted conditions can affect the genital skin.
- This guideline introduces the reader to some common skin conditions that might present on the genital skin (for STI related dermatology).
- Dermnetnz.org is a good reference.
Possible causes of dermatological symptoms are varied and may include:
- Normal anatomical variants
- Fungal: dermatophyte (tinea), candidiasis
- Viral: human papillomavirus (HPV), molluscum contagiosum, human herpes virus (HHV), human immunodeficiency virus (HIV)
- Bacterial: syphilis, donovanosis, Staphylococcus
- Parasites: scabies, lice
- Inflammatory conditions: eczema, psoriasis, lichen simplex, hidradenitis suppurativa
- Autoimmune conditions: lichen scleroses, lichen planus, inflammatory bowel disease-associated ulceration
- Trauma: sexual trauma, self-inflicted trauma, assault
- Malignancy: precancerous or cancerous lesions
- Other: fixed drug eruptions, medication side-effects (contact dermatitis).
|
Symptoms |
Consideration |
|---|---|
|
Itch |
Associated with the need to scratch – may be painful or pleasant |
|
Burning, stinging, dysaesthesia |
Unpleasant sensation not associated with a need to scratch |
|
Different appearance |
Colour (hyper- or hypo-pigmentation), red/purple, textured, pealing, tearing, fissured, dry, scaley, lichenified (thickened), abrasions, inflammation, sloughing moist skin, increased smegma (men and women), offensive smell |
|
Painful sexual intercourse, may include pain with non-penetrative sexual intimacy | |
|
Asymptomatic |
Signs of skin conditions found incidentally on examination |
|
Lesions |
Papules, cysts, pustules, plaques, scale, patches, ulcers, flat, raised, erythematous base, dry, moist, blistered, wart-like, generalised, individual, well demarcated, erosive, nodular |
Always examine from head to toe as many genital skin conditions are not sexually transmitted and can be found elsewhere – including nails, mouth, hairline, behind ears, natal cleft, buttocks.
- Any investigations will depend on the presenting complaint or clinical suspicion of infection – e.g. syphilis, HIV, hepatitis, herpes simplex virus (HSV).
- Many dermatological conditions do not require any investigations at the site.
- Use of photography for the patient record (to show regression or resolution of symptoms) or to send to a specialist is useful.
- Skin biopsy may be useful to confirm diagnosis.
- Paediatric presentations – refer to a specialist
- Severe associated anxiety – refer to psychological services.
|
Diagnosis |
Recommended |
Alternative |
|---|---|---|
|
Lichen simplex |
Topical mid or potent strength corticosteroid ointment, emollients, antihistamines | |
|
Lichen planus |
Potent topical corticosteroid ointment |
Requires specialist review |
|
Lichen sclerosis |
High strength topical corticosteroid ointment for several weeks then titrated to weekly use |
Requires specialist review, precancerous condition |
|
Dermatitis |
Topical mid or potent strength corticosteroid ointment, emollients |
Emollients to wash and moisturise |
|
Psoriasis |
Topical mid or potent strength corticosteroid ointment |
Emollients, specialist referral if severe |
|
Pruritis ani |
Daily mild topical corticosteroid ointment |
Antihistamines |
|
Hidradenitis suppurativa |
Doxycycline 100 mg daily |
Clindamycin 2% cream applied to affected area daily |
|
Scabies and lice |
Permethrin cream |
Ivermectin |
|
Syphilis | ||
|
HIV | ||
|
HSV |
Treatment advice
- Use an ointment on genital skin
- If no resolution refer to a sexual health service or dermatologist
- Refer to the specific guideline if a sexually transmitted infection (STI) is suspected or confirmed
Genital skin care
- 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
- Use emollients for washing and moisturising skin (e.g. sorbolene cream)
- Try lubricant or emollient to shave pubic hair.
- Review will depend on the presentation and management; sometimes several visits are required before the condition resolves or regresses.
- Review patients with lichen planus or lichen sclerosus at least annually once stable.
90% of patients with lichen sclerosus and lichen planus are under regular review.
- Russell DB, Bradford D, Fairley C, editors. Sexual Health Medicine. Melbourne Sexual Health Centre. Second edition. Melbourne: IP Communications; 2011.
- Genital Dermatology Atlas and Manual, Third Edition. 2017
