What is psoriasis?
Psoriasis is a very common skin condition found in at least 2% of the population. Many people have heard of psoriasis, but it is not well known that it can cause very long standing itchy red rashes on the vulva.
Typical psoriasis looks like raised red areas with white scale, most often found on the tips of your elbows and the front of the knees. Patients with psoriasis also tend to have a flaky itchy scalp. Many people with psoriasis don’t realise they have it. They just think it is normal to have scaly elbows and knees, or think they just have dandruff.
Psoriasis of the vulva is easy to diagnose if it is present elsewhere on the skin, but it can occur only on genital skin. When this happens it can be very difficult to diagnose because it doesn’t look like typical psoriasis on the rest of the skin. On the pubic area it is usually typical with well defined scaly red patches, but on the vulva itself it lacks the scale and sometimes the sharp edge of typical psoriasis.
Psoriasis on the vulva is easily mistaken for dermatitis or chronic thrush and in fact chronic thrush may occur together with psoriasis.
Psoriasis is usually redder than dermatitis and much more persistent and difficult to treat. Although it can look exactly like thrush it doesn’t get better with antifungal medications.
Psoriasis does not involve the vagina. It tends to be on the outer lips of the vulva, around the back passage, extending into the crack between the buttocks. It can go out onto the thighs and into the pubic hair. It is very itchy and can become sore from scratching and because the skin tends to split open.
Why does psoriasis happen?
Psoriasis runs in families. It is inherited and is a genetic condition. Although most people with psoriasis initially say they don’t have anyone in the family with it, most will discover a relative who has always had a tendency to have skin rashes.
Psoriasis gets worse when you are stressed, but it isn’t caused by stress. It is a genetic condition and this means it is just the way you are made.
Psoriasis can start at any age, even in babies. A lot of children with chronic vulval rashes have psoriasis.
How can I tell if I have psoriasis of the vulva?
If you have had a persistent itchy rash on the outside of the vulva, often for years, which gets a bit better with cortisone creams, then comes back as soon as they are stopped you may have psoriasis.Vulval psoriasis is typically itchy but it may become sore if you have scratched it until it is raw.
If you are not sure here are some clues:
- Do you have a family member with psoriasis, or if not known psoriasis with dandruff, chronic rashes on elbows, knees, hands and feet?
- Do you have scaly elbows and knees?
- Do you have dandruff?
- Do you have cracked heels?
- Do you have rashes on your hands?
- Do you have little dents or pits on the surface of your nails?
- Does the itch get worse when you are stressed?
There is no specific diagnostic test for psoriasis. Even a biopsy test (where a piece of skin is cut out and analysed) may not help. The diagnosis depends on your doctor’s judgement and is supported by family history and/or signs of psoriasis elsewhere on the skin.
A diagnosis of psoriasis can be distressing. You might well know people who have it severely and the thought that it may last for the rest of your life is pretty hard to take. It is important to put this in perspective. Psoriasis is common, in most cases not severe and on the vulva nearly always able to be controlled with creams, just as long as they are the right ones.
How do you treat psoriasis?
Treating psoriasis can be difficult and takes a lot of perseverance. Even when it is better, you usually have to keep applying a preventative treatment to stop it from coming back.
Psoriasis usually improves initially with cortisone creams, but these lose effectiveness after some weeks. Treatment with other creams that are used specifically for psoriasis is necessary to continue improvement and maintain control, and you need a management plan for flare-ups which occur from time to time.
The first thing to do is be kind to your skin.
In the initial stages of treating psoriasis you will need some treatment with a strong cortisone cream or ointment. See Treatment. Getting better may take up to four weeks on this treatment. This often takes at least four weeks. As soon you feel better and raw and split areas have healed you can commence a specific psoriasis treatment.
The creams that are usually used to treat vulval psoriasis include the following active ingredients:
- Tar creams
- Calcipotriol (Vitamin D)
- Salacylic acid
These products are applied in the morning with the cortisone applied at night.. Both are effective maintenance treatments for psoriasis. It usually takes several weeks for them to start working well. Be patient. The longer you stay with treatment, the better you will be.
Once you are better you can then reduce your cortisone to a weaker one and eventually stop using it completely or just use when needed, because flare ups do occur from time to time.
You will probably need to keep using your non-steroid creams daily to keep your psoriasis under control. There creams are very safe long-term.
If you are unable to control your vulval psoriasis with creams you may need more advanced therapy. It is probably time to ask for a referral to a dermatologist.
Psoriasis can be an unpredictable and therefore frustrating condition. It is a matter of trial and error to find the ideal maintenance and flare-up plan.
Apart from the medicines mentioned above there are a number of other maintenance formulations which can be helpful. Emollients such as Bepanthen® ointment, Amolin® cream or zinc and castor oil give many patients relief. It is important to remember that many psoriasis patients have unpredictable reactions to various preparations. Prolonged burning and stinging after using one treatment means that it should be discontinued, and another tried.
If there is something else going on as well, particularly thrush anti-fungal treatment is essential until the psoriasis is well-controlled. This is because many cases of psoriasis are driven by chronic candidiasis.
What will happen in the long term? Is psoriasis dangerous? Could I get cancer from it?
Although psoriasis is itchy and uncomfortable, it is not dangerous in any way and it is never associated with cancer. Once you get through the initial stages of getting it under control and get into the routine of a long term management plan, you will feel much better. And don’t forget stress management, which is so important in a condition that gets worse when you are stressed.