Vaginal psoriasis is a tricky thing for doctors because even generalized psoriasis is a tough nut to crack. The anogenital area is a site that can be the locus of rubbing and scratching. Genital psoriasis is tough.
The patient needs to understand that new lesions may be induced in normal skin by physical trauma, including scratching the unaffected skin or psoriatic lesions. Due to the generally warm and moist conditions in the vaginal area, psoriatic plaques in the body folds are usually not scaly, but are bright red and fissured. The sharp demarcation of the lesions allows physicians to differentiate between similar looking ailments like tinea cruris or Paget’s disease.
Psoriasis of the body folds and of female genitalia is especially vulnerable to the development of steroid-induced skin atrophy; low-potency steroids are often recommended but are not very effective. In addition, the fact that enthralling and tar preparations are very irritating in these areas poses a difficult problem in controlling vaginal psoriasis. Castellani’s paint is sometimes helpful in genital and perianal psoriasis. Vitamin D3 preparations are somewhat effective in these areas and carry no risk of skin atrophy. Tar baths are often very effective.
In the United States, it is estimated that three to five million people have psoriasis. Most have localized psoriasis, but over a quarter million people have generalized psoriasis requiring specialized approaches with ultraviolet radiation, photochemotherapy, and methotrexate and cyclosporine preparations.
There are numerous triggers that are major factors in eliciting lesions. Physical trauma such as rubbing and scratching stimulate the proliferative processes in vaginal psoriasis. An acute streptococcal infection can lead to guttate psoriasis. Stress is also a major factor.
Vaginal psoriasis is an immunologic phenomenon and, as such, is often treated with immunosuppressive drugs like cyclosporine – which is particularly effective in causing a total remission of genital psoriasis. There are many T cells present in psoriatic lesions surrounding the upper dermal blood vessels and therapies are designed in part on suppression of T cells.
Tazarotene is a relatively new topical retinoid developed as another alternative to glucocorticoids, or it can be combined with steroids. There is some indication that tazarotene may prevent skin atrophy.
Psoriasis, at its core, is a biochemical reaction. While normal skin cells take about a month to mature, patients with psoriasis have skin cells that over-multiply, forcing the cells to move up to the top of the skin in less than a week. As the number of cells builds up, the epidermis thickens and the cells pile up in raised, red and scaly lesions. The sometimes-extensive inflammation is caused from the buildup of blood needed to feed the rapidly dividing cells. Alcohol abuse makes psoriasis more aggressive and more difficult to treat and control.
Vaginal psoriasis carries with it a large emotional element. The embarrassment of having psoriasis on the vagina can cause a woman untold misery. Many women avoid intimacy altogether once they have been diagnosed or the first lesion appears. A lack of closeness to another can often cause stress and anxiety, further exacerbating the problem. Teenage girls can be the butt of jokes, and the humiliation of the disease causes female patients to suffer depression at a much higher rate than males.
