Psoriasis on the genitals of men and women

Psoriatic rashes in the intimate zone can appear in any person suffering from psoriasis. Diagnosis of their occurrence, as a rule, without difficulty, since rashes, localized only on the genitals, do not occur in practice ever. The patient has specific lesions in the skin in other places.

[2], [3], [5]

Epidemiology

Epidemiology of scaly lichen is well studied. Pathology is very common, 2-4% of the world's population suffer from psoriatic rashes. In developed countries, especially with a cold climate, the incidence rate is higher, the indigenous people of South America do not know this disease at all. The probability of getting sick in men and women is about the same, but the course of the disease in men is usually more severe. Approximately in a quarter of cases of psoriasis, the disease developed after epithelial injuries. The provoking factor of the onset or recurrence of the disease in 45% of patients was a bacterial infection, in particular - pharyngitis.

Hereditary predisposition to psoriasis is the most serious risk factor. In the presence of psoriasis in one of the parents the probability of getting a child is 14-25%, in both - the degree of risk increases more than twice. The probability of the disease in a healthy child is 12%.

Currently, two types of psoriasis are classified:

• the first type (early) is hereditary; it affects the female on average 16 years, the male at 22 years old, the course is severe, associated with antigens of tissue compatibility, in the risk group - persons with the phenotype HLA-Cw6;
• second type (late) - single cases of the disease, not associated with antigens of tissue compatibility; begins at about 60 years, the course is relatively easy, but in these cases often affected nails and joints.

Male subjects are prone to genital psoriasis more often than women. The disease develops usually in the age range from 25 to 50 years, in the risk group - people living in climatic zones, characterized mainly by low temperature and high humidity.

[7], [8], [9],

Causes of the genital psoriasis

There are several hypotheses about the etiology of the disease in general, and none of them is fully recognized, but in almost all assumptions the leading role is given to heredity. This is evidenced by the fact that in the family history of people suffering from psoriasis, this pathology is much more common than in the population as a whole.

The question of the type of inheritance of the disease is still open, but most of the data indicate the leading role of genetic factors in the pathogenesis of the disease. Be it a viral theory that explains the causes of the disease by retroviruses inherited genetically, or autoimmune. In any case, psoriatic skin lesions in people with a genetic predisposition arise, mainly in the presence of external or internal factors that weaken the immune system.

[12], [15]

Risk factors

Risk factors that activate rashes on the genitals:

• presence of papules and plaques on other parts of the body;
• heredity;
• fluctuations of the hormonal background (puberty, pregnancy, menopause, hormone therapy);
• diseases of the urogenital system;
• overstrain and stress;
• presence of chronic infectious diseases (tonsillitis, caries);
• traumatic disorders of the epidermis in the intimate zone;
• strong frosting or prolonged exposure to low temperatures, especially in a damp room;
• vaccination, taking medicines (psychotropic, cytotoxic, immunomodulators, NSAIDs), drug allergy;
• food allergies, food and alcohol intoxication;
• radical change in climatic conditions;
• chronic diseases: endocrine, neuropsychiatric, autoimmune, etc .;
• excess weight.

Psoriasis is not a contagious disease and it is impossible to get infected by it, even when blood is transfused from a sick person to a healthy one, psoriasis is not transmitted, which seriously contradicts the viral theory of the onset of the disease.

[16], [17]

Pathogenesis

The pathogenesis of psoriasis, like its original cause, remains an open question to date. It has now been established that the inherited immune response of peptide information molecules (cytokines) is of the greatest importance in the pathogenesis of this disease, leading to changes in skin keratinocytes.

Psoriasis of the genitals is not a separate disease, but only the localization of the rashes, and in most cases it is not the only one on the body. Scaly lichen can affect any part of the body, but there are areas of skin on the body from which the rashes practically do not go away. The overwhelming majority of patients have elbows and knees (98% of cases), chest and abdomen (96%), back and buttocks (95%). The scalp (78% of cases) is less common, the rashes on the face skin are found in every second case. Rashes on the genitals are not often found localization.

[18], [19], [20], [22], [23], [26], [27], [28], [29]

Symptoms of the genital psoriasis

Typical first signs of the disease of any localization - the appearance of rich pink or red papules, covered with loose silvery-gray scales.

Psoriasis of the genitalia in women is often associated with hormonal outbursts or deficits: a period of puberty, childbearing, a climax. Eruptions are found on the pubis, the skin of the labia majora, in the inguinal folds and, in some cases, mucous membranes of the labia minora are affected. As a rule, women, even those with psoriatic plaques of other localizations, take them for some kind of disease, gynecological or infectious.

Psoriasis on the labia has a rather specific appearance - a small reddish papules, clearly delineated, having the shape of a circle (oval), covered with silvery-gray scales. They usually do not itch.

Sexual psoriasis in men is localized on the penis, in the inguinal folds and on the pubic skin. The rashes look like pinkish-red papules with a clear border, slightly elevated above the surrounding surface, covered with silvery-gray scales. They usually do not itch and do not peel off. Psoriasis on the penis in a number of cases can spread to the inner surface of the prepuce. In men, as in women, it is almost always possible to find psoriatic plaques of other localities on the body.

Atypical form of this disease - inverse (reverse) psoriasis often proceeds heavily. In the natural folds of the inguinal skin, shiny, moist and smooth spots of bright red color are found, devoid of specific silver-gray scales. These areas on the body are regularly subjected to mechanical friction, which irritates the skin, it begins to itch, the surface is cracked, ulcerated, which is fraught with infection.

[30], [32], [33], [34]

Stages

The course of sexual psoriasis, like any other localizations, is sinusoidal - the period of remission is replaced by exacerbation, which is divided into the following stages:

• progressing - at this time new primary papules appear regularly, and already existing plaques increase;
• stationary, when the appearance of new formations stops and they are covered with scales, and old plaques stop growing (with an inversion form, the scales do not appear, the staining is simply stopped);
• regressing, characterized by the disappearance of symptoms, oriented from the center of the spots to their periphery.

On the genitals most often there are such kinds of psoriasis as vulgar and inverse.

[36], [38], [39]

Complications and consequences

The consequences and complications of late treatment to the doctor with the problem of psoriasis of the genitals can be very serious. If, in the initial stage, remission is usually achieved by applying external remedies, more serious therapy is later applied. In addition, as a result of the attachment of a bacterial or fungal infection, you can find suppuration, swelling, erythema, which greatly complicates both diagnosis and treatment.

Psoriasis of the genitals interferes with normal, regular sexual life; in patients, neuropsychic disorders are often observed. In men, psoriasis of the penis may be complicated by inflammation of the inner leaf of the foreskin (balostache), in women - with vaginitis.

The most frequent complications are exacerbations of clinical manifestations of the disease. On examination, psoriatic erythrodermia, pustular eruptions, and the worst case of joint damage are detected.

[40], [41], [42], [44], [45]

Diagnostics of the genital psoriasis

To determine the cause of the rash, a visual examination and a detailed interview of the patient are carried out. The doctor finds out if the patient has chronic illnesses, what events preceded the development of the disease, whether similar pathologies were found in close relatives, determines the necessary laboratory tests and additional examinations.

With the initial forms of the disease, blood tests are usually within normal limits.

In cases of atypical form of psoriasis in the intimate zone, a biopsy of the affected areas of the skin and its microscopic examination are prescribed to clarify the diagnosis. In addition, it is usually possible to find manifestations of the disease in other natural folds - axillary, gluteal.

Dermatoscopy can be prescribed - instrumental diagnostics used for skin pathologies.

Additional examinations are carried out on the initiative of the attending physician in order to find out the condition of the internal organs and accompanying diseases, as this may influence the choice of treatment methods (electrocardiography, thyroid ultrasound, abdominal organs, radiography).

Differential diagnosis

Differential diagnosis of eruptions on the genitals is performed after the collection of anamnesis, analyzes and results of additional studies in order to avoid an erroneous diagnosis and distinguish it from similar pathologies similar in clinical manifestations. It is necessary to exclude the presence of:

• papular syphilis;
• Reiter's illness;
• microbial eczema;
• fungal skin lesions;
• vulvitis;
• balance-post;
• cutaneous T-cell lymphoma;
• inguinal erythroderma and other skin pathologies, since the attachment of the infection can significantly lubricate the clinical picture of the disease.

Treatment of the genital psoriasis

Sexual psoriasis is treated, basically, as well as psoriasis of other localizations. More often complex therapy is used: local, systemic and physiotherapeutic procedures, however, for mild forms, monotherapy is used by external means or, for example, phototherapy. Anti-psoriasis drugs are usually prescribed in combination with antibacterial or antifungal agents to exclude infection.

When appointing treatment, the doctor takes into account the stage of the disease (progressive, stationary, regressive), the type and prevalence, the age of the patient and the accompanying pathologies. In order for the therapy to be effective, patients should adhere to recommendations on diet and skin care. Alcohol drinks, sharp and fatty meals are excluded from use, they limit easily digestible carbohydrates. In food, it is recommended to eat vegetable dishes, sour-milk products, fish and seafood, dietary meat, fresh fruits, berries and vegetables. Patients, especially in the progressing stage, should not expose the epithelium to mechanical action (combing, friction), procedures that irritate the skin surface are excluded.

In modern dermatology, try to minimize the use of cytostatics and glucocorticosteroids, given the serious side effects of their use. Nevertheless, to cope with the manifestations of the disease use complex hormonal drug Diprospan (dipropinate and disodium phosphate betamethasone). It significantly reduces allergic and inflammatory manifestations, normalizes the immune system. It has a weakly expressed mineralocorticoid action, but with short-term use of the remedy they can be neglected. Betamazone disodium phosphate ensures the speed of the drug. It is injected intramuscularly, dosing to 1-2 ml. Injections are done once a week by short courses. A single injection or a short period of administration of the drug, the purpose of which is to remove the acute condition, avoids serious side effects from the nervous system, psyche, and digestive organs that are possible with prolonged use or overdose. Diprospan is not used by pregnant and lactating women.

Can be appointed Neotigazon - a synthetic retinoid, effective in severe disease. The active ingredient - aceturitin, which inhibits the processes of cell division, growth and keratinization, stabilizes the cell membranes, normalizes the protective properties of the epidermis. Treatment begins with daily dosages of 25, 30, 50 mg (respectively, severity, flow and effectiveness). They take up to one month, then reduce to a supportive, determined individually. The course of maintenance therapy is up to two months. When the disease persists, the drug can be combined with other therapies: external, physiotherapy. Women of fertile age during the course of retinoids should be effectively protected from conception.

In the therapy of difficult-to-treat forms of psoriasis, the immunosuppressant Sandimmun Neoral (the active ingredient-cyclosporin A, a cyclic polypeptide consisting of 11 amino acids) is used quite successfully . Inhibits the activity of T-lymphocytes, the development of antibody production from them dependent and the reduction of their sensitization to antigens, blocking the growth factor of T-lymphocytes. Side effects depend on the dose and are reversible with the withdrawal of the drug, the most common are renal failure and hypertension. Duration of admission 2-3 months, maintenance therapy - up to one and a half months. During treatment, it is necessary to monitor the level of serum creatinine and blood pressure.

The choice of local drugs is considerable, depending on the type and severity of the rashes, you can choose different means - from simple non-hormonal ointments to corticosteroids. Medicinal forms - gels, lotions, solutions are not used in the treatment of mucous membranes, since they contain ethyl alcohol. However, these forms prevent the occurrence of a greenhouse effect with reverse psoriasis localized in the folds of the skin.

Hormonal ointments are known for their speed, and the systemic effect of local drugs is negligible. Usually the exacerbation is removed by a short course of steroid use, and the residual phenomena are eliminated with ointments that do not contain hormones.

Currently, most commonly prescribed complex drugs containing a hormonal active ingredient in combination with salicylic acid or an antibiotic. For example, Diprosalik ointment is a combination of betamethasone dipropionate, a highly effective glucocorticosteroid that removes inflammation, allergy and itching in a short time, and salicylic acid, which has exfoliating, antiseptic and repairable properties, and also conducts the hormonal component into the deeper layers of the epidermis. Ointment is applied twice a day, lightly rubbing. With the appointment of maintenance therapy, the frequency of application is reduced. Duration of treatment is prescribed by the doctor individually. Contraindicated in case of sensitization to components, tuberculosis and fungal lesions.

A similar active ingredient contains the Belosalik ointment.

In combination with salicylic acid ointment Elokom S (hormone component - mometasone furoate), Lorinden A (flumetasone pivalate) is produced.

Relatively recently appeared a combined Daivobet ointment containing a synthetic derivative of vitamin D - calcipotriol monohydrate and an effective corticosteroid - betamethasone dipropionate. Their combination actively reduces the symptoms of psoriasis. Calcpotriol increases the absorption of the hormonal ingredient, which contributes to a more pronounced anti-inflammatory and anti-allergic effect. Also this component slows down the processes of keratinocyte division and growth, normalizing the proliferation of epidermal cells. Experts note that the use of this ointment does not cause side effects and leads to a stable remission.

It is possible to use non-hormonal external means - Daivoniex  ointment, a monopreparation with active component calcipotriol. Has a pronounced exfoliating effect, quickly removing scaly skin, itching and normalizing the proliferation of keratinocytes.

Creams and ointments based on solidol with vegetable and mineral components, natural products of beekeeping are produced: Acrustal, Kartalin, Tsitopsor, Magnipurs, Antipsor, Solipsor, the producers of which promise a quick effect and prolonged remission.

In the treatment of squamous lichen, almost all vitamins are used. For example, the vitamin complex of Decamewith or Essentiale simultaneously with injections of fat-soluble vitamins A (daily dosage of 50-60 thousand units), D3 (10-15 thousand units), E (200 mg). The duration of treatment is 4-6 weeks at intervals of four weeks to eight.

Sometimes vitamin D3 is given in combination with calcium gluconate (500 mg three times a day) during the month with a mandatory regular check of the calcium content in the blood.

To eliminate psoriatic rashes, physiotherapy is widely used. In particular, photochemotherapy, with photosensitizing agents: Pouvalene, Beroxane, Psoralen or with a synthetic aromatized analogue of retinoic acid (tigazone). The affected skin is irradiated with ultraviolet long waves using a special PUVA unit. Reception of drugs is prescribed on the day of irradiation. With intolerance of photocoumarins or tigazone, PUVA therapy is prescribed without the use of drugs. Presumably, the effect of ultraviolet irradiation is due to the fact that representatives of antigens are eliminated from the skin using the procedure - Langerhans cells interacting with T-helpers, but remain-interacting with T suppressors. Improvement of the condition is caused by the predominance of the suppressor effect over the helper, which prevailed prior to PUVA therapy. And also, ultraviolet irradiation inhibits the production of nuclear DNA of keratinocytes, which reduces their proliferation.

Practices are also procedures with a photocoumarin applied to the skin or a bath with its solution.

In psoriasis, laser radiation of the blood is also prescribed; balneotherapy; magnetotherapy; electrophoresis with glucocorticosteroids; phonophoresis.

Sexual psoriasis can be complicated in men by inflammation of the penis (balanitis or balanstitis). Complicated phimosis - the inability to expose the head of the penis. With progressive phimosis and ineffective therapy, operative treatment is performed - excision of the foreskin (circumcision).

Alternative treatment

Psoriasis is a serious chronic disease, until today incurable. Psoriatic rashes on the genitals are no exception to this rule. Attempts to cope with the manifestations of the disease are fraught with sad consequences. However, there are a lot of tips how to relieve the condition when exacerbating, without leaving home. It is only necessary to take into account that alternative means do not always interact positively with medical appointments, therefore their practical application is desirable only after discussing the beneficial effect with the attending physician.

Alternative treatment for prolonging the latent period and alleviating the condition of the skin during exacerbations recommends home "balneotherapy":

• Healing sea baths.

They are prepared in the following proportions: in 50 liters of water, 250-500 g of sea salt are dissolved. First, the salt is added to the hot water so that it dissolves better, then, mixed with the cold, brought to the desired temperature (≈34-37 ° C) and volume. Sea baths for therapeutic purposes take at least 15, but not more than 25 minutes once with an interval of one day.

• Therapeutic baths with the addition of herbal medicinal herbs: soap, string, celandine, St. John's wort, valerian root or sage.

Procedures can be done every other day or every day. Herbal infusion is prepared from any of the listed herbs in this way: measure four tablespoons of crushed herbal raw materials and brew with a liter of boiling water. Leave to stand for at least six hours. Prepare a bath with a water temperature of 37-38 ° C, strain, pour into it infusion. The duration of the bath is not more than a third of an hour.

The course of home balneotherapy accounts for 15 to 20 baths. Leaving the bath, do not wipe, but only gently dry the skin with a towel.

Treatment with herbs in a home alternative medicine is the main place. When treating skin diseases it is recommended dandelion, this plant can have fresh flowers, stems and roots, make salads out of them, dry and cook jam. Dandelion cleans blood and liver well, removing toxins, which is important in such a complex multifactorial disease as psoriasis.

Dandelion oil in alternative medicine is positioned as a universal medicine. In skin diseases, especially dry epithelial lesions, a natural linen or cotton cloth moistened with oil is applied to the areas with rashes. This product can be prepared as follows: in the morning to collect the aboveground part of flowering plants on a fine sunny day (preferably, for a month forecast, too, without rain), grind until juice is separated and fill with ½ glass jars, topping up with any vegetable oil. Tie the neck of the can of gauze and put on a sunny place, insist for three weeks. After this period, squeeze out, filter. Put in storage in a dark place, but not in the refrigerator.

For skin diseases use a mixture of dry crushed dandelion roots and leaves of burdock. Mix a tablespoon of each plant's raw material. This mixture is soaked in three glasses of water for at least eight hours. They boil for ten minutes. They let cool and filter. Use five times a day at the same time inward (for ½ cup) and externally (lubricating lesions).

You can make a gruel from fresh dandelions and spread it with psoriatic crusts or squeeze out the juice. It's also good to make lotions of thistle juice. However, these procedures are feasible only in the summer, as long as there are fresh plants, preferably flowering. Plants need to be torn in ecologically clean places, the distance from which to the busy highways is not less than 1,5 km.

Seeds of harbor porridge are very effective in treating psoriatic rashes. After treatment with this herb, the promise of prolonged remission is promised. The infusion is prepared very simply: two tablespoons of seed are steamed for an hour in a thermos bottle. Strain, cool a little and make lotion on the rashes, during the procedure, moistening the tissue so that the affected areas are abundantly moisturized. The infusion is fresh every time. For 2-2,5 months of daily procedures, the skin is completely cleared and the latent period is promised from three to five years. Seeds of the seal are usually not sold in pharmacies, but they can be purchased in online stores, you need to order a collection of "Seeds of the Pestilence of the Garden." A course of therapy usually requires five or six packs.

You can prepare an ointment from the thick extract of the turn based on lanolin and petrolatum (1: 1: 1) and lubricate it with the affected skin.

The extract of the string is taken orally two weeks for 20 or 30 drops three times a day before meals.

Homeopathy - therapeutic treatment with small dosage doses of any one drug based on the principle of similarity and appointed personally by a homeopath physician taking into account all the personality characteristics of the patient, is usually effective and can lead to recovery. Having adjusted for serious and long treatment and performing all the doctor's prescriptions, it is possible to defeat the disease, having achieved a permanent remission. Especially when treating such a multifactorial and individual disease as psoriasis. You can take homeopathic preparations for as long as you want, as there are no undesirable effects from their administration. However, their appointment to themselves is unacceptable, it may be ineffectual, and may even hurt. To get individual appointments that will be most effective for a particular patient, you need to see a homeopathic doctor.

If it is not possible to get advice from a professional homeopath, pharmacy homeopathic medicines produced by pharmaceutical companies with homeopathic dosages and technological principles can be used.

Psoriaten ointment, with the main component - mahogany padubolic. The ointment is addressed to patients with the initial stages of the disease in mild form. It can be used for pregnant and lactating women under the supervision of a doctor.

In the homeopathic remedy, more than 30 medicines are mentioned for the treatment of different forms and localizations of psoriatic eruptions. The most commonly used of them and used in the pharmacy combined drugs, recommended for this disease.

Psorinocheel H - complex drops containing 11 basic drugs used to treat psoriasis (psorinum, sulfur, thuya, natura muratikum, etc.). The drug removes inflammation and intoxication, normalizes immunity, removes manifestations of exudation. Activating the internal reserves of the body, Psorinocheel H stops the degenerative process in the skin and promotes its regeneration. Dosage is individual. The standard scheme involves starting treatment with a single drop twice or thrice a day, each day increasing one dose per drop to 8-10 drops, which drip directly under the tongue and retained there until absorbed. It is possible to dissolve a single dose of the drug in 5ml of water or to drip a daily rate in a glass of water and drink during the day at regular intervals (the solution is stored in a dark place).

The Loma Lux Lux Psoriasis solution contains homeopathic dilutions of nickel and potassium sulfate, potassium, sodium, zinc bromide. Hydrobromic acid salts are able to regulate the functioning of the immune system, reduce the production of proinflammatory factors and stimulate cellular renewal. Nickel salt of sulfuric acid reduces the surface sensitivity of the skin and helps detoxify the body, catalyzing metabolic processes. Potassium - moisturizes and eliminates peeling, tones and normalizes cellular respiration. Contraindicated in case of sensitivity to ingredients, renal failure, during childbearing and feeding. Dosage is proportional to the body weight of the patient, from half to two teaspoons is taken on an empty stomach once and within an hour abstain from eating and drinking.

Homeopathic granules Psoroderm - a complex preparation of seven ingredients:

• Bufo (Bufo rana) - affects the central nervous urogenital, lymphatic system, heals the skin;
• Natrium muriaticum (Natrium muriaticum) - is shown at considerable infringements of a metabolism, dry and ekssudativnyh rashes;
• Oleander (Oleander) - skin diseases, accompanied by itching, increased irritability from contact with clothing;
• Psorinum (Psorinum) - has an effect on the lymphatic system, skin and mucous membranes, secretory glands, nervous system; is prescribed for chronic diseases that are difficult to treat;
• Sulfur (Sulfur) - strengthens the immune system, is prescribed for many chronic dermatoses;
• Thuja (Thuja) - abnormal growths of tissues, rashes, growths, dry skin;
• Cicuta virosa (Cicuta virosa) - a positive effect on the epithelial surface of the skin and mucous membranes, the brain and spinal cord.

Take 5-7 krupin sublingually twice a day for half an hour before eating, dosing to maintain remission - 7 cereals a day once. Duration of therapy from two weeks to four, repeat at intervals of one week to a month.

Complex homeopathic preparations can be administered in combination with other means of psoriasis. It is necessary to observe an interval of not less than half an hour between the methods of different drugs.

Homeopathic preparations are not compatible with black coffee, mint tea, sweets, inhalations, camphor-menthol medicines.

[47], [48]

Prevention

Since the causes of the disease are not established, then preventive measures are not easy to determine. However, there are recommendations, observing which can significantly prolong the periods of remission and relieve relapses:

• periodically, preferably in the spring and autumn, to cleanse the body of toxins to improve the functioning of the excretory organs and to relieve the skin from overload (this can be done with the help of ready-made supplements, infusions, alternative methods for cleaning);
• follow the normal work of the intestine, do not allow diarrhea and constipation or alternation;
• try to exclude from the menu for a month or two gluten (contained in cereals) and lactose (in dairy products), if the condition improves, then it is necessary to exclude them forever;
• Do not overeat;
• use sea water (you can water her affected areas of the body once a day, if there is no possibility to arrange sea bathing);
• when cooking, use sea salt;
• take a half-hour hot (≈ 38-39 ° C) bath with a saturated infusion of licorice, which is considered a natural cortisone;
• use brewer's yeast, linseed oil and nettle (in any form: fresh - in salads and borsch, dried - in tea and infusion).

[53]

Forecast

As a rule, experts give a completely favorable for life prognosis of sexual psoriasis, especially of its light forms. But you need to realize that this is followed by the appointment of a doctor, because the treatment can be quite difficult and time-consuming, and also - a healthy lifestyle.

[54], [55], [56], [57]