Vulval psoriasis

Question 1

Definition of vulval psoriasis

Answer 1

Chronic inflammatory epidermal skin disease
affecting approximately 2% of the general population.
Genital psoriasis may present as part of plaque or flexural psoriasis or, rarely, as the only area affected.

Question 2

Signs of vulval psoriasis

Answer 2

. Well-demarcated brightly erythematous plaques
. Often symmetrical
. Frequently affects natal cleft
. Usually lacks scaling due to maceration
. Fissuring
. Involvement of other sites, e.g. scalp, umbilicus

Question 3

Symptoms of vulval psoriasis

Answer 3

. Vulval itch
. Soreness
. Burning sensation

Question 4

Complications of vulval psoriasis

Answer 4

. May be worsened due to Koebner effect by irritation

from urine, tight-fitting clothes or sexual intercourse.

Question 5

Diagnosis of vulval psoriasis

Answer 5

. Clinical presentation.
. General examination of the skin and nails to look
for other signs of psoriasis.

Question 6

Investigations for vulval psoriasis

Answer 6

Punch biopsy if in doubt of diagnosis

Question 7

Treatment of vulval psoriasis

Answer 7

. Avoidance of irritating factors.
. Use of emollient soap substitute.
. Topical corticosteroid – weak to moderate steroids
are preferred but if insufficient to induce a response
then intensive short-term potent steroids such as clobetasol propionate 0.05% may be used. A combined
preparation containing antifungal and/or antibiotic
may be required if secondary infection was suspected
(e.g. Trimovate).
. Weak coal-tar preparations – may be used alone or
combined or alternated with topical steroids.
However, these preparations can cause irritation
and folliculitis.
. Vitamin D analogues such as Talcalcitol – alone or in
combination with corticosteroid; however, their usefulness may be limited by causing irritation