Lichen sclerosus of the vulva and perineum in women

Lichen planus (LP) of the vulva, as an isolated lesion or a manifestation of widespread LP, can be characterized by polygonal papules typical for this dermatosis or atypical: pigmented, erosive, hypertrophic elements [1-3].

Among the atypical forms of vulvar LP, the most rare is hypertrophic. Typically, the hypertrophic form of LP manifests itself as itchy purple papules and polygonal plaques with a Wackham mesh on the surface, affecting mainly the lower extremities - the legs, as well as the ankle and interphalangeal joints. In this case, histological signs characteristic of LP, such as hypergranulosis and basal cell vacuolar degeneration, may be absent [4]. This circumstance should be taken into account when performing histological confirmation of this form of LP. The histological diagnosis of hypertrophic LP is complicated by the presence of pseudocarcinomatous hyperplasia (PCH) of the epidermis in long-term lesions that are constantly injured by scratching, which can be difficult to distinguish from squamous cell carcinoma (SCC) of the skin [5].

Clinical observation

Patient B

., 68 years old, was admitted to the department of dermatovenerology and dermato-oncology of MONIKI with complaints of intensely itchy rashes on the skin of the torso, limbs and genitals. She believes that she fell ill 15 years ago, when, against the background of menopause, she noted the appearance of intense itching of the genitals, and therefore the gynecologist recommended the local use of baby cream, pumpkin and sea buckthorn oils. Despite the increased itching, she did not consult a doctor. After 10 years, an itchy light pink spot appeared in the area of the right ankle joint. A local dermatologist diagnosed eczema and prescribed local treatment with corticosteroid ointments (without effect). Over the next 4 years, the lesion continued to increase in size. A year ago, after the death of her husband, the itching sharply intensified, new rashes appeared on the skin of the torso and upper extremities, and therefore she was hospitalized in the department of MONIKI.

On examination: the pathological process is widespread, symmetrical, localized on the skin of the limbs, torso and genitals. On the skin of the lower extremities, mainly the legs and ankle joints, there are hypertrophic papules and plaques of a violet-brown color with a cellular surface, clear boundaries and mealy peeling on the surface, as well as atrophic pale pink plaques with a purple rim along the periphery (Fig. 1, 2 ).

Rice. 1. Patient B. Hypertrophic plaque of purple-brown color in the ankle joint.

Rice. 2. The same patient. An atrophic pale pink lesion with a violet rim along the periphery in the area of the ankle joint and lower leg. When illuminated from the side and the elements are lubricated with oil, a network of whitish lines is visualized on the surface. On the skin of the left forearm there is a longitudinal lilac plaque with a honeycomb surface, 5x10 cm in size. On the skin of the chest there are multiple polygonal pink-violet shiny papules with a central umbilical depression. The mucous membrane of the labia minora is whitish; in the area of the left labia minora a dense hypertrophic whitish plaque with a spongy surface was detected. Multiple small erosions and excoriations were noted on the mucosa of the labia majora and minora (Fig. 3).

Rice. 3. The same patient. A dense hypertrophic whitish plaque with a spongy surface on the mucous membrane of the labia minora, against this background there are small erosions. The nails on the upper extremities have longitudinal striations.

Laboratory examination data: results of a general urine test, blood coagulogram, blood test for thyroid hormones, glycemic profile within normal limits.

Histological examination of the lesion on the mucous membrane of the genital organs: epidermis with compact orthohyperkeratosis, focal hypergranulosis, uneven acanthosis, apoptosis of single keratinocytes; in the upper parts of the dermis there is fibrosis, angiomatosis, perivascular lymphohistiocytic infiltrates. Conclusion: histological changes may correspond to the hypertrophic form of LP.

The patient received treatment: pentoxifylline 5.0 ml per 100.0 ml of saline intravenous drip every other day; chloropyramine intramuscularly at night 2.0 ml; vitamins B1, B6 1.0 ml intramuscularly every other day, vitamin B12 500 mcg once a day intramuscularly, tetracycline 0.1 g orally 2 times a day for 10 days, delagil 0.25 mg orally 2 times a day course for 20 days, locally on lesions in the area of the trunk and limbs, applications of Akriderm ointment 2 times a day, on the genitals - applications of 0.1% Protopic cream 2 times a day.

A week after the start of treatment, there was a significant reduction in itching and flattening of the lesions in the torso, limbs and genitals. 20 days after the start of treatment, the itching disappeared, the rash almost completely regressed with the formation of pigmentation and congestive hyperemia, and on the genitals - depigmentation and atrophy (Fig. 4).

Rice. 4. The same patient after treatment. a — significant flattening of the lesions in the area of the right shin; b - the plaque in the area of the left shin has softened and turned pale; c — depigmentation and atrophy at the site of former lesions in the area of the external genitalia.

Diagnostics

In advanced stages, it is difficult to confuse lichen sclerosus with any other disease.
At the same time, in the initial stages, the pathology has common symptoms with diabetes mellitus, vitiligo or vulvovaginitis. This may cause confusion. Diagnosis of pathology always begins with a questioning and examination of the woman. Already at this time, an experienced physician will be able to suspect the presence of lichen and make a preliminary diagnosis.

To confirm it, he may prescribe a regular or extended vulvoscopy (a procedure during which the tissues of the vulva are examined using a colposcope).

As for laboratory tests, they may include:

blood test for glucose;
PCR (to detect HPV);
cytological examination of material taken from the tissues of the external genitalia (necessary to exclude cancer);
immunogram (to understand whether the patient has immune disorders).

Pityriasis rosea on the penis

The disease has an unknown origin.

It develops mainly in young adults or teenagers.

The disease is acute.

Recovery occurs on its own, a few weeks after the appearance of the rash.

The pathology is characterized by autumn-spring seasonality.

Among the subjective symptoms, itching dominates.

Of four people:

one has severe itching;
in two people – moderate;
another one is completely missing.

In 80% of cases of the disease, one large maternal plaque initially appears, and then other elements of the rash appear along the periphery.

This plaque measures up to 5 cm in diameter.

There is peeling in its center.

The plaque is surrounded by a pink corolla.

Hence the name of the disease.

In some patients, several such plaques are detected on the body at once.

Secondary elements of the rash are papules.

They can also appear on the penis.

Although the main localization is the abdomen and limbs.

The rash associated with pityriasis rosea is characterized by an arrangement in the form of spruce branches.

They appear on lines of skin stretch, friction or pressure.

Atypical clinical forms of pityriasis rosea:

absence of maternal plaque, presence of only secondary rashes;
several maternal plaques;
the rash may not be papules, but blisters, including those with bloody contents, spots or pustules (pustules).

Diagnostics

The basis of diagnosis is a skin biopsy.

Parakeratosis, minor signs of acanthosis, and spongiosis are noted in the epidermis.

There is no granular layer.

Signs of dyskeratosis are detected.

In the dermis, the doctor sees swelling, homogeneous collagen fibers, and lymphocytic infiltration.

However, a biopsy is not always prescribed.

A doctor can make a diagnosis based on the clinical signs of the disease alone.

In most patients they last no more than 6 weeks.

If this period has passed, and there are still symptoms of pityriasis rosea on the penis, the doctor will prescribe a skin biopsy.

Because in this case he must carry out differential diagnosis with other diseases:

parapsoriasis;
guttate psoriasis;
chronic migratory erythema.

Treatment

The disease goes away on its own.

Accordingly, treatment, if required, is exclusively symptomatic.

Antihistamines are used to reduce itching.

Light therapy can be used for the same purpose.

An alternative may be sunbathing (if the climate and time of year permit).

Going to a solarium can alleviate a person’s condition.

Rash and peeling on the genitals: what could it be?

There are several types of lichen on the list of suspects. Some require mandatory treatment, while others may present a surprise - they will go away on their own and for no reason.

Lichen planus

The most mysterious lichen, since doctors still cannot determine the etiology of this dermatosis. Potential culprits include dysfunctions of the central nervous system or immune system and viruses. The incidence rate is low - 1-2% of the entire world population; victims most often are adults who have crossed the 40-year mark. Those at risk of contracting this sexual pathology are those for whom frequent stressful situations and contact with stray animals are common.

LP in men is as rare as in women, with the only exception being its oral form, which prefers the weaker sex. The main symptoms are skin rashes. They are flat, rise slightly above its surface, have a crimson-red color, irregular shape, and a diameter of 3 to 5 mm. Then, merging, the spots form large plaques on the genitals.

Lichen planus on the penis is characterized by the following manifestations:

papules that are flat-topped and shiny;
rashes in the absence of itching;
lichen on the penis has a characteristic mesh pattern called Wickham's sign;
If you injure the skin of the penis, another element of the rash will appear at the site of the wound.

Lichen planus of the vulva and vagina can be suspected by the following list of symptoms:

The initial stage is characterized by the appearance of white stripes in the area of the labia. There is no itching or burning during this period.
But there is pain during penetrative sex due to the narrowing of the vaginal opening during illness.
It is possible that the color of the vulva may change to pale white, pink or red, as well as the formation of weeping lesions. Green or yellow discharge may occur.

Pityriasis versicolor

The culprit of this type of lichen on the genitals is known for certain - it is a yeast-like fungus that exists in three forms: Malassezia furfur, Pityrosporum ovale and Pityrosporum orbiculare. These diseases can easily transform into each other. They usually behave peacefully, but extremely unfavorable conditions contribute to their rapid growth, which leads to pathology in the genital area. The disease prefers men, people with large body weight, those who suffer from hyperhidrosis, and also have oily skin.

This lichen has other names - multi-colored, colored, summer and sunny.

Lichen versicolor begins with the appearance of numerous tiny spots on the body that do not rise above the surface of the skin. They have an irregular shape, and their edges are not clearly defined. Their color changes from flesh to brown. Later the spots will fade. Intense tanning does not change the picture.
The affected areas peel slightly, but there is no pain. Without treatment, their area inexorably increases, the result is a large flaky spot.
Pityriasis versicolor practically does not bother the owners; sometimes mild itching and some discomfort during sexual intercourse are noticed.

Diagnosis of this dermatosis is not too difficult. Identification of lichen versicolor is based on the detection of fungal mycelium by laboratory methods.

Pityriasis rosea

This type, also called Zhiber's disease, is of an infectious-allergic nature. Just like the pityriasis variety, which is active in the summer, pityriasis rosea tends to be seasonal - it runs amok in the spring and autumn. This acute dermatosis often appears after a person has had a cold without seeing a doctor.

Men and women who are promiscuous should undergo a full examination by a venereologist at least 2 times a year.

The causative agent of pityriasis rosea is still considered the main subject of debate: some argue that herpesvirus type 7 is to blame, others believe that the culprit is the respiratory syncytial virus.

How it manifests itself:

First, one or 2-3 maternal plaques appear on the body. Their color is bright pink, their diameter can reach 5 cm. Peeling is noticeable in the center, which soon disappears.
Then the color of the mother's spots changes: they become yellow-brown, and a pink border appears around the perimeter of the affected areas. This resemblance to a medallion makes it easier for dermatologists, so diagnosing this pathology of the genital organs is very simple.
After about a week or two, the patient discovers other rounded elements on the body: they are the same color, but smaller in size, which is why they are called daughter elements. Localization sites can be any area of the skin, the genitals are no exception. Over time, the younger spots in the center turn yellow and, just like the larger ones, acquire a pink border.

The duration of the appearance of new elements is 2-3 weeks, then the spots reluctantly fade and then disappear completely, leaving healthy areas of the skin without pigmentation. But the skin will successfully restore its previous color after a short period of time.

Shingles

The disease is caused by viruses belonging to the herpetic family - Varicella-zoster. They are famous for the fact that they can provoke 2 different diseases at once - herpes zoster, which is also called herpes zoster, and chickenpox. It is the latter pathology that is responsible for the occurrence of this lesion of the reproductive system. Having had chickenpox in childhood, the child’s body acquires a new and quiet “tenant” who can remind of its presence several years and even decades later.

If you find yourself with these signs, consult a doctor immediately!

All you need is a push - a problem in the functioning of the immune system. Further developments are not long in coming:

The disease begins with a simple malaise, followed by an increase in temperature and pain, the intensity of which can vary. Redness occurs in areas of future rashes.
After a few days, bright red bubbles appear on the surface of the skin; they are the size of the head of a pin. More often they are located in isolation, without a tendency to merge.
The transparent contents turn into pus after a week, then the cavities are opened, leaving crusts in the localized areas.
After they disappear, pigmentation remains on the affected areas, which can persist for quite a long time.

Genital herpes is extremely rare. In women, the development of the disease takes longer than in men.

Lichen sclerosus

This skin pathology has another name - lichen. She almost always specializes in the genitals (80%). It occurs in both men and women, but women suffer from it 10 times more often. Children are less likely to be targeted, but gender also plays a role: in most cases, girls are targeted. The cause of lichen sclerosus also remains a sealed mystery. There are two versions explaining its occurrence - autoimmune and infectious.

The disease develops over years. Due to the fact that the rashes do not cause discomfort, many do not even suspect the presence of problems with the health of the reproductive system. Ringworm begins with the appearance of white papules with clearly defined boundaries. In addition to the genitals, localization sites can include the upper chest, shoulders and neck. Their maximum diameter is 5 mm; due to their compact arrangement, they subsequently also merge into plaques.

Such a spot rises slightly above the surface of the skin, sometimes small bubbles are present on the plaque. The skin on the genitals may itch only occasionally, but dryness is always felt. The disease is wavy, the affected area can change size - decrease or increase.

Lichen sclerosus is not as harmless as its “colleagues”. Women and girls may be at risk for squamous cell carcinoma. Such cases are rare (3%), but this skin disease should not be neglected. It is also dangerous for men - failure to see a doctor in a timely manner will lead to recurrent balanitis and phimosis.

Diagnostics

If a rash appears on the pubis or genitals, you should contact a dermatovenerologist. The diagnosis of lichen can be made based on the following studies:

initial examination, history taking;
microscopic examination of a skin sample from the site of the lesion (for this, a scraping is taken);
irradiation with a special lamp;
clinical blood test.

Research helps to determine the nature of lichen - infectious, neurological or allergic, and to choose adequate treatment. Additionally, a test is carried out for the presence of sexually transmitted infections.

A blood test may be needed to make a diagnosis

Localization Features

Rash with lichen on the genitals differs depending on the type of pathology. Manifestations of the disease in women and men may be different. Foci of the disease form both on the skin and on the mucous membrane of the genital organs.

In men

Ringworm affects the surface of the penis and its head. Mild pathology often goes away on its own. But some types of genital rash require proper and timely treatment. Such diseases include scleroatrophic and lichen planus.

The disease can manifest itself on the male genital organs with the following symptoms:

formation, papules, plaques, erosions and blisters;
changes in skin color in affected areas;
pain, especially during sexual intercourse;
itching;
pronounced inflammatory process;
decreased reproduction;
urinary disorders;
decreased level of sperm activity.

With the scleroatrophic type of lichen, atrophy of the skin and narrowing of the foreskin are often observed.

Among women

Ringworm can affect the skin area of the vulva. In this case, clusters of lesions are often observed in areas of the labia. The rash is also sometimes localized in the groin area.

At the site of the lesions occurs:

swelling of the skin;
rash character, which depends on the type of lichen;
itching sensation;
pain during sexual intercourse and urination;
dryness and flaking.

With lichen sclerosus, bleeding in the area of the lesions, coarsening and thickening of the mucosal tissues can be observed.

Ringworm in the genital area is treatable in both men and women. To speed up the recovery process and increase the effectiveness of therapeutic actions, you should contact a medical center for help at the first signs of the disease. Timely diagnosis of skin pathology on the genital organs will help to correctly prescribe treatment and reduce the risk of complications. All medications are prescribed by the attending physician.

Features of localization in men and women

Each type of pathology on the genital organs has its favorite places.

Lichen planus on the glans penis looks like a ring formed by small papules. The scrotum as well as the preputial sac may be affected. In women, white stripes first appear near the labia, then the skin turns red, and in case of complications, the lesion also appears in the vagina.
Pityriasis versicolor, starting with small papules, eventually affects the groin and genital area, spreading over the entire head of the penis. This lichen on the scrotum occurs more often than others.
Lichen sclerosus on the foreskin is considered a rare disease for which conservative methods are not suitable, therefore it must be treated radically - by circumcision. Otherwise, the disease will spread to the skin of the glans and urethra of the penis, which already threatens complications. Lichen sclerosus in women is located on the vulva, in the anus.

What are the risks for the sick person and his partner?

Whether it is possible to receive lichen as a “gift” through sexual contact with an infected person depends on the state of the person’s immunity, as well as on the type of disease. That is why such dermatoses are called conditionally infectious.

The most unpleasant ones on the list are the girdling and pink subspecies:

Shingles cannot be contracted through airborne droplets; close contact is required, especially sexual contact. Using the patient's personal belongings also threatens with bad consequences. But these warnings apply only to the stage of the disease when a new rash appears. If the blisters are covered with scabs, the disease automatically becomes non-contagious.
Due to little knowledge of the mechanism of activation of pityriasis rosea, it is not possible to accurately answer the question of its contagiousness. Therefore, it is assumed that this dermatosis is transmitted infrequently by contact. Doctors still recommend abstaining from sexual activity during illness, because sweat and water procedures are not the best companions for this dermatosis.

Ringworm of the labia

1 Characteristics of genital lichen
2 Reasons for appearance
3 Is lichen in the labia area contagious?
4 Diagnosis and treatment

One of the dermatological diseases of the genital organs is lichen on the labia. The disease is characterized by the appearance of an inflammatory process, irritation and rash in the genital area. The disease affects women of any age group. The lesions are localized on the labia minora, labia majora, and perineum. To effectively treat such a disease, it is necessary to eliminate the causes of the disease.

Characteristics of genital lichen

Common types of diseases affecting the lips major and minor are:

lichen planus;
simple chronic lichen.

Their main manifestations at different stages of the disease are summarized in the table:

Manifestations

Red

Simple chronic

Initial stage Small white stripes in the labia area Foci of irritation and inflammation on the mucous membrane of the vagina, in the genital area Itching, burning Completely absent Present in the vulva area Development of the disease Redness of the skin in the vestibule of the vagina, the labia minora stick together Reddened areas are covered with individual hyperpigmented reddish plaques -brown color Pain During sexual intercourse During urination and sexual intercourse Complications The vagina becomes red, its walls and lesions begin to peel off, bleed with slight touch The mucous membrane thickens, becomes rough, the walls of the vagina narrow, the rash spreads to the entire perineum

Reasons for appearance

The main reasons for the appearance of lichen in the genital area include:

constant mechanical irritation of the labia from scratching and friction;
the use of chemical sources of skin irritation: washing powders, perfume hygiene products;
chronic diseases of the reproductive system, internal organs;
weakening of the body's protective functions;
psychological stress, nervous stress.

Is lichen in the labia area contagious?

The main reason for the development of the disease is the inability of a weakened human immune system to resist external stimuli. Therefore, lichen on the labia is a non-infectious disease and is not transmitted through direct and sexual contact with infected people, as well as through the use of shared hygiene items.

Diagnosis and treatment

For diagnosis, a scraping of the lichen is taken.
The following methods are used to diagnose the disease:

Microscopy. Scrapings from the affected areas are examined under a microscope, cells characteristic of lichen are identified.
Biopsy. A laboratory analysis of plaque tissue fragments is carried out and pathological changes are determined.
Allergy tests. Allergy tests are carried out to determine the sensitivity of the human body to various allergens.

Medical therapy

The main goals of treating lichen in the genital area are:

elimination of the causes of the disease;
elimination of symptoms of the disease;
strengthening the immune system.

Effective medications and their medicinal properties in the fight against the disease are presented in the table:

Medication

Therapeutic effect

“Fluocinonide”, “Aristocort”, “Protopic” Relieve inflammation and flaking Relieve itching “Atarax”, “Benadryl” Have an antispasmodic, sympatholytic, mild analgesic effect Relieve itching and irritation “Hydrocortisone”, “Kenalog”, “Valizon” Provide anti-inflammatory, anti-allergic, immunosuppressive effect Stop the pathological process "Clobetasol", "Triamcinolone" Eliminate allergic manifestations Prevent the development of infection Vitamin A Renews cells Normalizes the metabolic process Strengthens the immune system "Psoril" Relieves irritation and peeling of the skin Restores cells and tissues of the mucous membranes Ethacridine lactate, "Chlorhexidine" Provides antiseptic, disinfectant effect

To enhance therapeutic therapy, traditional medicine is used. Treating the affected areas with decoctions of calendula, chamomile, and horse sorrel relieves inflammation and improves the condition of the damaged areas. To prevent lichen on the labia, it is recommended to wear underwear made of high-quality natural materials, monitor genital hygiene, and use disinfectants if irritation or scratches occur. To prevent the development of the disease, it is necessary to strengthen the immune system and maintain personal hygiene.

Discussion

Due to the anatomical and physiological characteristics of the vulva (high humidity, the influence of friction, occlusion, high sensitivity to secondary infection), dermatoses in this area have a clinical uniqueness and are often characterized by atypical forms [6]. This is important to take into account in the differential diagnosis of such a precancerous form of LP as hypertrophic.

First of all, hypertrophic LP of the vulva should be differentiated from verrucous carcinoma of the vulva, characterized by asymptomatic, slowly growing exophytic lesions, rarely accompanied by ulceration. Histologically, it manifests itself as acanthotic cords with minimal nuclear atypia, areas of hyperkeratosis on the surface of the tumor with minimal keratin formation within it, as well as diffuse chronic inflammation of the stroma [7].

In such cases, the presence of Wackham's mesh lesions on the surface, as well as the presence of lesions of the oral mucosa and nails characteristic of LLP, may indicate in favor of LP.

Like other chronic inflammatory diseases characterized by scratching and inflammation, hypertrophic vulvar SCC may be accompanied by signs of epidermal SCC, which is usually difficult to distinguish from cutaneous SCC [4, 5].

The difficulty of differential diagnosis of hypertrophic LP of the vulva with SCC of the skin is also associated with the possibility of malignant transformation of the former [8]. The importance of distinguishing these processes is evidenced by four cases of erroneous diagnosis of RCC in hypertrophic LP described in the literature [4, 9].

SCC of the skin is characterized by hyperplasia of the epidermis and adnexal epithelium, severe irregular acanthosis with the formation of horny cysts, infiltration of the reticular layer of the dermis, vascular and perineural invasion. Unlike SCC, SCC of the epidermis is not accompanied by infiltration of the reticular layer of the dermis, as well as vascular and perineural invasion [4, 9].

Therefore, when performing histological verification of hypertrophic LP, a deep biopsy of the lesion should be performed, sufficient for a differential diagnosis with RCC [5].

Histological features of hypertrophic LP include orthohyperkeratosis, wedge-shaped hypergranulosis and psoriasiform epidermal hyperplasia [10], as well as lichenoid borderline dermatitis with the presence of eosinophils [11]. In this case, the presence of typical signs of PCD of the epidermis is possible, but there is no cytological atypia, pronounced solar elastosis, deep spread of acanthotic cords into the dermis, vascular and perineural invasion [4, 9].

Staining for elastin to identify perforated elastic fibers can help distinguish hypertrophic LP from SCC, which is rarely observed in hypertrophic LP and often observed in skin SCC [12, 13].

Vulvar LP is usually treated with applications of corticosteroids or angioneurin inhibitors (tacrolimus and pimecrolimus ointments). In severe cases resistant to therapy, methotrexate and cyclosporine are used [2].

Experience in the treatment of vulvar hypertrophic LP is limited, which is due to the rarity of the pathological process. Only one report indicated the effectiveness of intralesional injections of corticosteroid hormones in this disease [14].

The danger of skin pathologies on the face

Shingles becomes the most dangerous when it appears on the face. It can have an ocular form - spread to the orbital nerve, causing inflammation of both eyelids, the skin on the forehead, nose, and crown area. Ringworm on the eye also appears in case of damage to the maxillary nerve. Infection on the cornea can lead to blindness. If scaly lichen appears on the eyelid, this is also dangerous due to loss of clarity of vision and is fraught with pain.

If fungal lichen is not treated properly, a number of consequences are possible:

development of a chronic form of the disease;
inflammation on the skin will spread to the eyes and mouth;
spread to other areas of the body;
relapses;
scars.

Characteristics of lichen planus

The disease manifests itself in the form of rashes - papules. Their sizes can vary significantly, and some formations merge with each other.

Their shape is called irregular because the rashes are flat. The color can vary from light to pink or blue. Their main difference from other types of lichen is their shiny surface.

It is not difficult to distinguish this type of lichen in the groin in men from other pathological changes when lubricating the skin with oil. In addition, a fine mesh can be found on the affected area, which determines this type of disease.

If the skin is damaged, new papules may form in this area. The following types of lichen occur on the surface of the genital organ:

with the ring-shaped type, the papule begins to sink and a ring forms around it;
the serpiginous type of the disease involves the appearance of rashes in the form of clear figures;
on all sides the papules are covered with scales in lichen corneum;
hypertrophic lichen causes the formation of entire groups of blue papules;
with lichen pigmentosa, a small spot first appears, and then a papule appears in its place;
lichen vesica causes the appearance of small blisters on the surface of the skin, which are filled with blood and therefore have a characteristic bright color;
with a flattened form of the disease, all formations have a flattened shape and a small depression in the middle.

Effective ointments/creams for lichen on human skin

If such a rash occurs, intolerable itching may occur. At the same time, the urinary process is not disrupted. However, sexual functions may be affected due to painful acts.

Treatment of different types of lichen

Each type of this pathology of the reproductive system requires both a specific treatment and a different duration. If the disease is diagnosed on time, then you can get rid of it in 1-3 weeks, otherwise recovery may take several months.

Treatment of lichen planus is carried out comprehensively: antihistamines, sedatives, and vitamins A and B are prescribed. A severe form requires the use of corticosteroid hormones and ointments containing them. As an additional therapy, compresses from infusions of medicinal herbs - eucalyptus, chamomile or sage are recommended.
In the question of how to treat pityriasis rosea, diet plays an important role. Be sure to exclude coffee and tea, alcohol, concentrated and spicy foods, canned food and smoked foods from your diet. Antihistamines and immunostimulating drugs are prescribed as medications.
For pityriasis versicolor, a similar diet is also necessary. Local antifungal agents are used: Lamisil, Nizoral, Mycozolon. A combination of local therapy and tableted antimycotics is allowed if the first method is not effective enough.
Herpes zoster involves the prescription of antiviral drugs - Famciclovir, Valacyclovir. Sedatives and analgesics are used, and brilliant green or its analogues are used for disinfection.
Lichen sclerosus in men often requires surgery to remove the foreskin. Women are treated with medication: injections of drugs containing heparin and lidase are used. Steroid ointments are considered especially effective. Creams containing petroleum jelly or zinc oxide are applied as skin care products.

Any form of lichen in the genital area should be treated only as prescribed by a doctor. Different medications have their own contraindications and compatibility, so self-medication can greatly harm yourself.

Types of diseases

The following types of dermatosis appear on the pubis, penis in men, and labia in women:

athlete's foot;
pityriasis versicolor;
pityriasis rosea;
lichen planus.

A common feature of different types of lichen is a rash and itching at the site of the lesion. Symptoms can occur not only in the groin area, but also on the chest, back, skin of the flexor surfaces, and between the toes.

Athlete's inguinal

Athlete's foot is a lichen in the groin area caused by a fungal infection. The disease occurs in several stages:

small red or pink spots appear on the skin, their surface peels off;
peripheral growth of spots occurs, the inflammatory process occurs along the edge, in the center its intensity decreases;
large spots merge and form edematous ellipsoidal lesions with uneven (fringed) edges;
Pustules and yellow crusts appear inside the lesions, the boundaries of the lesion are covered with small vesicles (bubbles);
in the center of the lesion, inflammation weakens, the skin turns pale, and weeping bulges appear at the borders.

In the area of epidermophytosis foci (on the genitals and pubis), slight itching is observed. The course of the disease is chronic, with alternating exacerbations and remissions. Relapse occurs most often in summer, in hot weather, when the intensity of sweating increases.

Multi-colored uniform

Pityriasis versicolor is fungal in nature. Fungi are permanent residents of the epidermis in areas of the body rich in sebaceous glands. Under favorable (for pathogens) conditions, they cause disease. Pityriasis versicolor appears as small brown or reddish spots with a clear boundary.

Ringworm Zhibera

Pityriasis rosea on the penis in men and the labia in women is an infectious-allergic manifestation. The causative agent of the disease is one of the herpes viruses. Most often it occurs in males due to stronger sweating in the groin area. The disease occurs in several stages:

a single pink plaque appears on the skin or mucous membrane;
the center of the plaque turns yellow, it wrinkles and begins to peel off;
Multiple small pink spots appear on the skin.

The disease does not require special treatment and goes away on its own after a few weeks. If you have pityriasis rosea, you should limit water procedures, because they contribute to the spread of the rash.

Lichen planus

Lichen planus (Wilson's disease) on the genitals is a non-infectious disease of unknown etiology. Experts identify two main causes of lichen – neurological and toxic-allergic. Lesions of Wilson's inguinal lichen are flat, red, flat papules with a waxy sheen.

Lichen sclerosus of the vulva

This factsheet provides an overview of what vulvar lichen sclerosus is, what causes it, and what treatment options are available. It also provides recommendations on how best to cope with the disease.

What is lichen sclerosus?

Lichen sclerosus is a progressive, chronic, benign disease of the skin and mucous membranes that most often affects the genital area (85–98% of cases), but can also occur in other areas of the body (15% of cases). This disease usually develops before or during menopause, but can occur even in children. The incidence of the disease is not precisely known. On average, it is observed in 1 out of 59 women who consult a gynecologist, and in 300 out of 1000 women who consult a dermatologist. Lichen sclerosus causes changes in the epithelium (surface cells) of the skin and mucous membranes - the structure of the epithelium changes, the skin and mucous membranes become thinner (but sometimes vice versa - the mucous membranes thicken or hypertrophy), local inflammation appears. The vagina is not affected.

What causes the disease to develop?

The cause of lichen sclerosis is unknown. The disease has been associated with various mechanisms, but none of them has been definitively confirmed, for example:

Genetic factors - the disease is more common in close relatives.
Immunological factors are disturbances in the functioning of the immune system that cause autoimmune reactions in the skin and mucous membranes (autoimmune diseases occur when the body's protective cells and proteins begin to destroy their own body cells and thus interfere with their normal function). The disease is more common in women with other autoimmune diseases - lupus, thyroid diseases, vitiligo, diabetes, etc.
Hormonal factors - low levels of estrogen (female sex hormones).

Local processes in the skin - dysregulation of markers that affect the normal development of skin cells.
Infection - the disease has been associated with various bacteria and viruses, but no study has shown a clear relationship.

What are the symptoms, complaints and consequences?

The most common complaints are itching, burning, a feeling of dryness, pain in the external genitalia, perineum, and sometimes around the anus. If the skin around the anus is also affected, the patient may experience pain during bowel movements.
The skin becomes white and pale. Lesions may be focal or may affect the entire area of the vulva and around the anus.
There may be purple-red spots on a white background, erosion and ulcers, which are often caused by scratching the skin.
The disease causes the appearance of scars in the area of the external genitalia, as a result of which they may become deformed - the labia minora may disappear (merging with the labia majora) or the entrance to the vagina may narrow.
Sexual dysfunction - pain during sex, psychological problems.
Problems with urination (pain).
In 10% of women with lichen sclerosus, white spots are observed in the vulva area and on other parts of the body - for example, on the back, in the waist area, under the mammary glands.
Some women have no complaints at all, and the disease is diagnosed accidentally during an examination.

How is the disease diagnosed?

Diagnosis is usually made based on characteristic signs found when examining the affected skin. Sometimes, to confirm the diagnosis, it is necessary to take a sample from the skin or mucous membrane for a biopsy - the area is numbed and a piece of tissue is removed, which is then examined under a microscope. A biopsy is a simple procedure that can be done as an outpatient procedure in your doctor's office. A biopsy is indicated when the diagnosis is unclear, initial therapy does not produce results, or there is a suspicion of a tumor process.

What treatment options are available?

All women with lichen sclerosus require treatment (even if there are no complaints). It is important to understand that we are talking about a chronic disease that, as a rule, cannot be completely cured. However, with the help of medications, its symptoms can be successfully controlled. The goal of treatment is to relieve itching and pain and reverse skin changes. Medicines do not affect already formed scar tissue. When treatment is interrupted, the disease usually worsens, and itching, burning and skin changes appear again.

The most effective and preferred treatment is an ointment or cream containing glucocorticosteroids, and in rare cases, intradermal injections. At the initial stage of therapy, the affected area is lubricated 1-2 times a day for 1-3 months; then the medicine will need to be used 1-2 times a week. The exact treatment regimen will be determined by your attending physician according to the severity of your disease.

The medicine is applied in a thin layer; Usually, to lubricate the skin and mucous membrane in the vulva area, it is enough to squeeze a small amount of ointment/cream onto your finger.

In addition to a drug containing a glucocorticosteroid, you can also use:

topical cream or vaginal tablets containing estrogen (the female sex hormone), especially if dryness in the vulva and vagina is a problem during menopause and causes pain during sex;

softening and moisturizing ointments, oils.

All bacterial and fungal infections in the vulva require treatment.

Surgical treatment is required in rare cases - mainly only in the presence of uncomfortable scars and adhesions.

Hygiene requirements for the vulva

In addition to using medications, maintaining regular and proper hygiene is very important. Any skin irritation should be avoided.

For washing, you should use washing gels for intimate hygiene that are odorless and non-irritating.
Deodorizing soap should not be used.
Prolonged contact with detergents should be avoided. They should be used last when taking a bath or shower.
You should wear cotton underwear, and sleep at night without any underwear.
When washing, you should use detergents for sensitive skin. Do not use fabric softeners.
If you experience pain during sex, you should use a natural lubricant.

ITK883 Information material was approved by the Quality Commission of Medical Services of the Ida-Tallinn Central Hospital on June 26, 2019 (protocol No. 11-19).

Prevention

To prevent the occurrence of lichen in the genital area, you must adhere to the following recommendations:

Eat properly. The daily diet must include foods containing minerals and vitamins. It is necessary to exclude the intake of allergenic, harmful and non-beneficial foods.
Monitor the state of immune defense. Ringworm often affects people with reduced immunity, so you need to saturate the body with vitamins, avoid stressful situations, prevent colds and lead a healthy lifestyle.
Comply with all hygiene standards. Regularly perform water procedures on the genitals. Wash your genitals only with high-quality, harmless detergents.
Regularly visually inspect the skin of the genital organs. It is quite easy to cure lichen at the initial stage. When the disease is advanced, the pathology is often accompanied by complications and can become chronic.

Rashes often form at the site of damage to the skin, so you should avoid damaging the epidermis in the genital area.