Genital psoriasis in men and women

Psoriatic rashes in the intimate area can appear in any person suffering from psoriasis. Their occurrence is usually diagnosed without difficulty, since rashes localized only on the genitals are never encountered in practice. The patient's skin is found to have specific lesions in other places.

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Epidemiology

The epidemiology of psoriasis is well studied. The pathology is quite common, 2-4% of the world's population suffers 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 approximately the same, but the course of the disease in men is usually more severe. In about a quarter of cases of psoriasis, the disease developed after damage to the epithelium. The provoking factor for the onset of the disease or its relapse in 45% of patients was a bacterial infection, in particular pharyngitis.

Hereditary predisposition to psoriasis is the most serious risk factor. If one of the parents has psoriasis, the probability of the child getting the disease is 14-25%, if both parents have it, the risk level more than doubles. The probability of the disease developing in a child of healthy parents is 12%.

Currently, two types of psoriasis are classified:

• the first type (early) is hereditary, it affects females on average at 16 years of age, males at 22 years of age, the course is severe, associated with tissue compatibility antigens, at risk are individuals with the HLA-Cw6 phenotype;
• the second type (late) – isolated cases of the disease not associated with tissue compatibility antigens; begins at about 60 years of age, the course is relatively mild, but in these cases the nails and joints are often affected.

Males are more susceptible to genital psoriasis than women. The disease usually develops between the ages of 25 and 50, and those at risk are those living in climate zones characterized mainly by low temperatures and high humidity.

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Causes genital psoriasis

There are several hypotheses about the etiology of this 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 data indicate the leading role of genetic factors in the pathogenesis of the disease. Whether it is a viral theory, explaining the causes of the disease by retroviruses inherited genetically, or an autoimmune one. 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.

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Risk factors

Risk factors that activate genital rashes:

• the presence of papules and plaques on other parts of the body;
• heredity;
• fluctuations in hormonal levels (puberty, pregnancy, menopause, hormone therapy);
• diseases of the genitourinary system;
• overexertion and stress;
• the presence of chronic infectious diseases (tonsillitis, caries);
• traumatic damage to the epidermis in the intimate area;
• severe freezing or prolonged exposure to low temperatures, especially in a damp room;
• vaccination, taking medications (psychotropic, cytostatic, immunomodulators, NSAIDs), drug allergy;
• food allergies, food and alcohol intoxication;
• radical change in climatic conditions;
• chronic diseases: endocrine, psychoneurological, autoimmune, etc.;
• excess weight.

Psoriasis is a non-infectious disease and it is impossible to get infected sexually, even through a blood transfusion from a sick person to a healthy one, psoriasis is not transmitted, which seriously contradicts the viral theory of the origin of the disease.

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Pathogenesis

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

Genital psoriasis is not a separate disease, but just a localization of 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 the skin on the body from which rashes almost never go away. In the vast majority of patients, these are the elbows and knees (98% of cases of the disease), chest and abdomen (96%), back and buttocks (95%). The scalp is affected somewhat less often (78% of cases of the disease), rashes on the skin of the face occur in every second case. Rashes on the genitals are not a common localization.

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Symptoms genital psoriasis

Typical first signs of the disease in any location are the appearance of deep pink or red papules covered with loose silvery-gray scales.

Genital psoriasis in women is often associated with hormonal surges or deficits: puberty, pregnancy, menopause. Eruptions are found on the pubis, the skin of the labia majora, in the groin folds, and in some cases the mucous membranes of the labia minora are affected. As a rule, women, even those with psoriatic plaques in other locations, mistake them for some disease, gynecological or infectious.

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

Genital psoriasis in men is localized on the penis, in the groin folds and on the pubic skin. The rash looks like pinkish-red papules with a clear border, slightly raised above the surrounding surface, covered with silvery-gray scales. They usually do not itch or flake. Psoriasis on the penis in some cases can spread to the inner surface of the prepuce. In men, as in women, you can almost always find psoriatic plaques in other locations on the body.

An atypical form of this disease - inverse psoriasis - often has a severe course. In the natural folds of the skin of the groin area, shiny, moist and smooth spots of a bright red color are found, devoid of specific silvery-gray scales. These areas of the body are regularly subjected to mechanical friction, which irritates the skin, it begins to itch, the surface cracks, ulcerates, which is fraught with the addition of an infection.

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Stages

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

• progressive - at this time, new primary papules regularly appear, and existing plaques increase in size;
• stationary, when the emergence of new formations stops and they become covered with scales, and old plaques stop growing (with the inverse form, scales do not appear, the growth of spots simply stops);
• regressive, characterized by the disappearance of symptoms, oriented from the center of the spots to their periphery.

The most common types of psoriasis on the genitals are vulgaris and inversa.

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Complications and consequences

The consequences and complications of late treatment with genital psoriasis can be quite serious. If at the initial stage remission is usually achieved by using external treatments, then later more serious therapy is used. In addition, as a result of the addition of a bacterial or fungal infection, suppuration, edema, erythema can be detected, which significantly complicates both diagnosis and treatment.

Psoriasis of the genitals prevents normal, regular sexual life, patients often have neuropsychiatric disorders. In men, psoriasis of the penis can be complicated by inflammation of the inner layer of the foreskin (balanposthitis), in women - by vaginitis.

The most common complications are exacerbations of clinical manifestations of the disease. During examination, psoriatic erythroderma, pustular rashes, and, as the worst option, joint damage are detected.

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Diagnostics genital psoriasis

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

In the initial stages of the disease, blood tests are usually within normal limits.

In cases of atypical psoriasis in the intimate area, a biopsy of the affected skin areas and its microscopic examination are prescribed to clarify the diagnosis. In addition, manifestations of the disease can usually be found in other natural folds - armpits, gluteal.

Dermatoscopy may be prescribed – an instrumental diagnostic test used for skin pathologies.

Additional examinations are carried out at the initiative of the attending physician to determine the condition of the internal organs and concomitant diseases, as this may affect the choice of treatment methods (electrocardiography, ultrasound of the thyroid gland, abdominal organs, radiography).

Differential diagnosis

Differential diagnostics of genital rashes is carried out after collecting anamnesis, tests and results of additional studies in order to avoid erroneous diagnosis and distinguish it from pathologies similar in clinical manifestations. It is necessary to exclude the presence of:

• papular syphilis;
• Reiter's disease;
• microbial eczema;
• fungal skin lesions;
• vulvitis;
• balanposthitis;
• cutaneous T-cell lymphoma;
• inguinal erythroderma and other skin pathologies, since the addition of an infection can significantly blur the clinical picture of the disease.

Treatment genital psoriasis

Genital psoriasis is treated in the same way as psoriasis in other locations. Complex therapy is most often used: local, systemic and physiotherapeutic procedures, however, in mild forms, monotherapy with external agents or, for example, phototherapy is used. Antipsoriatic drugs are usually prescribed in combination with antibacterial or antifungal agents to prevent infection.

When prescribing treatment, the doctor takes into account the stage of the disease (progressive, stationary, regressive), type and prevalence, age of the patient and concomitant pathologies. For the therapy to be effective, patients must adhere to recommendations on diet and skin care. Alcoholic drinks, spicy and fatty foods are excluded from consumption, easily digestible carbohydrates are limited. It is recommended to eat vegetable dishes, fermented milk products, fish and seafood, dietary meat, fresh fruits, berries and vegetables. Patients, especially in the progressive stage, should not expose the epithelium to mechanical stress (scratching, friction), procedures that irritate the skin surface are excluded.

In modern dermatology, they try to use cytostatics and glucocorticosteroids as little as possible, given the serious side effects of their use. However, to relieve the manifest manifestations of the disease, they use the complex hormonal drug Diprospan (betamethasone dipropionate and disodium phosphate). It significantly reduces allergic and inflammatory manifestations, normalizes the immune system. It has a weak mineralocorticoid effect, but with short-term use of the drug, it can be neglected. Betamazone disodium phosphate ensures the rapid action of the drug. It is administered intramuscularly, dosing 1-2 ml. Injections are done once a week in short courses. A single injection or a short period of administration of the drug, the purpose of which is to relieve an acute condition, helps to avoid serious side effects from the nervous system, psyche, digestive organs, which are possible with long-term use or overdose. Diprospan is not used by pregnant and lactating women.

Neotigazon, a synthetic retinoid effective in severe cases of the disease, may be prescribed. The active ingredient is acetritin, which inhibits cell division, growth and keratinization, stabilizes cell membranes, and normalizes the protective properties of the epidermis. Treatment begins with daily doses of 25, 30, 50 mg (depending on the severity, course and effectiveness). They are taken for up to one month, then reduced to maintenance, determined individually. The course of maintenance therapy is up to two months. In case of persistent disease, the drug can be combined with other methods of therapy: external, physiotherapy. Women of fertile age should effectively protect themselves from conception during the course of retinoids.

In the treatment of difficult-to-treat forms of psoriasis, the immunosuppressant Sandimmune Neoral (the active ingredient is cyclosporine A, a cyclic polypeptide consisting of 11 amino acids) is used quite successfully. It inhibits the activity of T-lymphocytes, the development of antibody production dependent on them and a decrease in their sensitization to antigens, blocking the growth factor of T-lymphocytes. Side effects depend on the dose and are reversible when the drug is discontinued, the most common are renal failure and hypertension. The duration of administration is 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 preparations is considerable, depending on the type and severity of the rash, you can choose different products - from simple non-hormonal ointments to corticosteroids. Dosage forms - gels, lotions, solutions are not used when treating mucous membranes, as they contain ethyl alcohol. However, these forms prevent the occurrence of a greenhouse effect in inverse psoriasis, localized in the folds of the skin.

Hormonal ointments are known for their rapid action, and the systemic effect of local preparations is insignificant. Usually, an exacerbation is relieved by a short course of steroids, and residual effects are eliminated by ointments that do not contain hormones.

Currently, the most commonly prescribed drugs are combination drugs containing a hormonal active ingredient in combination with salicylic acid or an antibiotic. For example, Diprosalic ointment is a combination of betamethasone dipropionate, a highly effective glucocorticosteroid that relieves inflammation, allergies and itching in a short time, and salicylic acid, which has exfoliating, antiseptic and reparative properties, and also conducts the hormonal component into the deeper layers of the epidermis. The ointment is applied twice a day, rubbing in lightly. When prescribing maintenance therapy, the frequency of application is reduced. The duration of treatment is prescribed by the doctor individually. Contraindicated in case of sensitization to the components, tuberculosis and fungal lesions.

Belosalik ointment contains similar active ingredients.

In combination with salicylic acid, the ointment Elokom C (hormonal component - mometasone furoate), Lorinden A (flumethasone pivalate) is produced.

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

You can use non-hormonal external agents - Daivonex ointment, a monodrug with the active component calcipotriol. It has a pronounced exfoliating effect, quickly removing scaly skin, itching and normalizing the proliferation of keratinocytes.

Creams and ointments based on solidol with plant and mineral components, natural bee products are produced: Akrustal, Kartalin, Tsitopsor, Magnipsor, Antipsor, Solipsor, the manufacturers of which promise a quick effect and long-term remission.

Almost all vitamins are used in the treatment of psoriasis. For example, the vitamin complex Decamevit or Essentiale simultaneously with injections of fat-soluble vitamins A (daily dosage of 50-60 thousand IU), D3 (10-15 thousand IU), E (200 mg). The duration of treatment is 4-6 weeks with intervals from four to eight weeks.

Sometimes vitamin D3 is prescribed in combination with calcium gluconate (500 mg three times a day) for a month with mandatory regular checking of calcium levels in the blood.

Physiotherapeutic treatment is widely used to eliminate psoriatic rashes. In particular, photochemotherapy, with photosensitizing agents: Puvalen, Beroxan, 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. Drugs are prescribed on the day of irradiation. In case of intolerance to photocoumarins or tigazone, PUVA therapy is prescribed without the use of drugs. Presumably, the effect of ultraviolet irradiation is due to the fact that with the help of the procedure, representatives of antigens are eliminated from the skin - Langerhans cells interacting with T-helpers, and those interacting with T-suppressors remain. The improvement in the condition is caused by the predominance of the suppressor effect over the helper effect, which prevailed before PUVA therapy. Also, ultraviolet radiation inhibits the process of production of nuclear DNA of keratinocytes, which reduces their proliferation.

Procedures with photocoumarin applied to the skin or baths with its solution are also practiced.

For psoriasis the following are also prescribed: laser blood irradiation; balneotherapy; magnetic therapy; electrophoresis with the use of glucocorticosteroids; phonophoresis.

Genital psoriasis may be complicated in men by inflammation of the penis (balanitis or balanposthitis), complicated by phimosis - the inability to expose the head of the penis. In case of progressive phimosis and ineffective therapy, surgical treatment is performed - excision of the foreskin (circumization).

Alternative treatment

Psoriasis is a serious chronic disease, incurable to this day. Psoriatic rashes on the genitals are no exception to this rule. Attempts to cope with the manifestations of the disease on your own are fraught with sad consequences. However, there are many tips on how to alleviate the condition during an exacerbation without leaving home. It is only necessary to take into account that folk remedies do not always interact positively with medical prescriptions, so their practical use is advisable only after discussing the beneficial effect with the attending physician.

Traditional medicine recommends home “balneotherapy” to prolong the latent period and alleviate the skin condition during exacerbations:

• Medicinal sea baths.

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

• Medicinal baths with the addition of infusions of medicinal herbs: soapwort, succession, celandine, St. John's wort, valerian root or sage.

The procedures can be done every other day or daily. Herbal infusion is prepared from any of the herbs listed in the following way: measure out four tablespoons of crushed herbal raw materials and brew with a liter of boiling water. Let it brew for at least six hours. Prepare a bath with water temperature of 37-38°C, strain, and pour the infusion into it. The duration of taking a bath is no more than a third of an hour.

A course of home balneotherapy includes 15 to 20 baths. After leaving the bath, do not wipe yourself, but only lightly dry your skin with a towel.

Herbal treatment takes the main place in home folk medicine. Dandelion is recommended for treating skin diseases; you can eat fresh flowers, stems and roots of this plant, make salads from them, dry them and cook jam. Dandelion cleanses the blood and liver well, removing toxins, which is important for such a complex multifactorial disease as psoriasis.

Dandelion oil is positioned as a universal medicine in folk medicine. For skin diseases, especially dry lesions of the epithelium, apply natural linen or cotton fabric soaked in oil to the areas with rashes. This product can be prepared as follows: in the morning, collect the above-ground part of flowering plants on a fine sunny day (it is desirable that the forecast for the month is also without rain), grind until juice is released and fill glass jars with the mass to ½, adding any vegetable oil to the top. Tie the neck of the jar with gauze and put it in a sunny place, insist like this for three weeks. After this period, squeeze out, filter. Put it in a dark place for storage, but not in the refrigerator.

For skin diseases, use a mixture of dry crushed dandelion roots and burdock leaves. Mix a tablespoon of each plant. Soak this mixture in three glasses of water for at least eight hours. Boil for ten minutes. Let it cool and strain. Use five times a day, both internally (½ a glass) and externally (lubricating the affected areas).

You can make a paste of fresh dandelions and spread it on psoriatic crusts or squeeze juice onto the crusts. It is also good to make lotions with milk thistle juice. However, these procedures are only feasible in the summer, while there are fresh plants, preferably flowering ones. Plants should be picked in ecologically clean places, the distance from which to busy highways is at least 1.5 km.

Portulaca oleracea seeds are very effective in treating psoriatic rashes. After treatment with this herb, a long-term remission is promised. The infusion is very easy to prepare: two tablespoons of seeds are steamed for an hour in a thermos. Strain, cool slightly and make compresses on the rash, wetting the cloth during the procedure so that the affected areas are abundantly moisturized. The infusion is prepared fresh each time. In 2-2.5 months of daily procedures, the skin is completely cleared and the latent period is promised from three to five years. Portulaca seeds are usually not sold in pharmacies, but they can be purchased in online stores, you need to order the collection "Seeds of Portulaca oleracea". Five or six packages are usually enough for a course of therapy.

You can prepare an ointment from a thick extract of the succession plant based on lanolin and petroleum jelly (1:1:1) and lubricate the affected skin with it.

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

Homeopathy is a therapeutic treatment with small medicinal doses of any one drug, based on the principle of similarity and prescribed personally by a homeopathic doctor taking into account all the personal characteristics of the patient, is usually effective and can lead to recovery. Having tuned in to serious and long-term treatment and following all the doctor's instructions, you can defeat the disease, achieving permanent remission. Especially in the treatment of such a multifactorial and individual disease as psoriasis. You can take homeopathic drugs for as long as you like, since no undesirable effects from taking them have been noted. However, prescribing them to yourself is unacceptable, it can be ineffective, and can even harm. To get individual prescriptions that will be most effective for a particular patient, you must contact a homeopathic doctor.

If it is not possible to obtain advice from a professional homeopath, you can use pharmacy homeopathic medicines produced by pharmaceutical companies in compliance with homeopathic dosages and technological principles.

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

The homeopathic medical book mentions more than 30 medicinal products for the treatment of various forms and localizations of psoriatic rashes. The most frequently used of them are used in the composition of pharmacy combination products recommended for this disease.

PsoriNoheel N is a complex of drops containing 11 main preparations used to treat psoriasis (psorinum, sulfur, thuja, natrium muratikum, etc.). The preparation relieves inflammation and intoxication, normalizes immunity, and removes manifestations of exudation. By activating the body's internal reserves, PsoriNoheel N stops the degenerative process in the skin and promotes its regeneration. Dosage is individual. The standard regimen involves starting treatment with one drop twice or three times a day, increasing the single dosage by one drop each day until reaching 8-10 drops, which are dripped directly under the tongue and held there until absorbed. It is possible to dissolve a single dose of the preparation in 5 ml of water or drip the daily dose into a glass of water and drink it at regular intervals throughout the day (store the solution in a dark place).

Loma Lux Psoriasis solution contains homeopathic dilutions of nickel and potassium sulfate, potassium bromide, sodium, and zinc. Salts of hydrobromic acid are able to regulate the functioning of the immune system, reduce the production of pro-inflammatory factors and stimulate cellular renewal. Nickelium salt of sulfuric acid reduces the superficial sensitivity of the skin and promotes detoxification of the body, catalyzes metabolic processes. Potassium - moisturizes and eliminates peeling, tones and normalizes cellular respiration. Contraindicated in case of sensitivity to the ingredients, renal failure, during pregnancy and breastfeeding. Dosage is proportional to the patient's body weight, from half to two teaspoons are taken on an empty stomach once and refrain from eating and drinking for an hour.

Homeopathic granules Psoroderm is a complex preparation of seven ingredients:

• Bufo (Bufo rana) – has an effect on the central nervous, genitourinary, lymphatic systems, improves skin health;
• Natrium muriaticum – indicated for significant metabolic disorders, dry and exudative rashes;
• Oleander – skin diseases accompanied by itching, increased irritability from contact with clothing;
• Psorinum – has an effect on the lymphatic system, skin and mucous membranes, secretory glands, nervous system; prescribed for chronic diseases that are difficult to treat;
• Sulfur – strengthens the immune system, prescribed for many chronic dermatoses;
• Thuja – pathological tissue growths, rashes, growths, dry skin;
• Cicuta virosa – has a positive effect on the epithelial surface of the skin and mucous membranes, the brain and spinal cord.

Take 5-7 grains sublingually twice a day half an hour before meals, dosage for maintaining remission is 7 grains per day once. Duration of therapy is from two to four weeks, repeat at intervals of one week to a month.

Complex homeopathic preparations can be prescribed in combination with other psoriasis remedies. It is necessary to maintain an interval of at least half an hour between taking different medications.

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

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Prevention

Since the causes of the disease have not been established, it is not easy to determine preventive measures. However, there are recommendations, following which you can significantly extend the periods of remission and alleviate relapses:

• periodically, preferably in spring and autumn, cleanse the body of toxins to improve the functioning of the excretory organs and relieve the skin from overload (this can be done with the help of ready-made dietary supplements, infusions, and folk methods for cleansing);
• monitor normal bowel function, prevent diarrhea and constipation or their alternation;
• try to exclude gluten (found in cereals) and lactose (in dairy products) from your menu for a month or two; if your condition improves, then you should exclude them forever;
• do not overeat;
• use sea water (you can spray it on the affected areas of the body once a day if it is not possible to go swimming in the sea);
• use sea salt when cooking;
• take half-hour hot (≈ 38-39°C) baths with a rich infusion of licorice, which is considered a natural cortisone;
• use brewer's yeast, flaxseed oil and nettle (in any form: fresh - in salads and borscht; dried - in tea and infusion).

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Forecast

As a rule, specialists give a very favorable prognosis for life for genital psoriasis, especially its mild forms. But you need to realize that this is based on following the doctor's orders, because the treatment can be quite complex and lengthy, as well as a healthy lifestyle.

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