DR BRYAN

HEY DOC… SOMETHING JUST DOESN’T LOOK RIGHT DOWN THERE!

For some patients with a skin problem affecting their groin or genital area, these are the sorts of thoughts that eventually spur them to book an appointment to see me at my clinic. Perhaps they have noticed a change in appearance, colour or simply due to symptoms around their genitals like itch or burning. And I don’t mean changes that arise due to a sexually transmitted infection, I refer to rashes or lumps and bumps.

It might be hard to believe, especially for any readers who have never had any problems with their skin before, but no-matter how badly affected one might be by a skin disorder, I have met patients for whom relationships have broken down, their sex life has disappeared, and self-confidence completely depleted. Many feel alone and often delay discussing genital skin problems with a doctor due to embarrassment or fear. When I teach doctors and nurses, I always stress the importance of never forgetting to ask about genitals when diagnosing a new rash that can affect this area. A lot of skin problems can be easily treated with the correct prescription, so my advice to you and my patients is never to presume anything nor rely on ‘Dr Google’, but to speak to your GP or arrange to see a dermatologist who can correctly diagnose the issue then start treatment.

So… first for a short skin anatomy lesson! The skin is our body’s largest organ, covering everything and including the external genitalia. In those with a penis, the shaft and outer foreskin are skin, but the glans (some call this the helmet) is a mucosal non-skin surface. On the other hand, in those with a vulva and vagina; the vulval labia, or external folds and including the clitoral hood, are skin. Everything deeper and more internal is mucosal. A mucosal service, different to skin, is a moist protective layer that lines organs and body openings including the genitals and other sites such as the anus, lips and nostrils. Some skin disorders can affect both the genital skin and mucosal surfaces, like lichen planus or warts, however, for the most part, rashes like eczema just affect the skin.

tags. Many genital skin rashes can also affect the skin around the anus and buttock, including the area between the genitals and anus called the perineum.

• Psoriasis can look red, orange or pink, but with less scale than when it affects the scalp or other body sites. Some patients also notice brittle nails with psoriasis, whilst others might develop a type of arthritis.

• Various types of eczema can affect the genitalia and sufferers usually complain of itch. Atopic eczema, which can affect anywhere on the body but usually first appears on the elbows and knees, often develops in childhood. Sufferers might also have hay fever or asthma. Seborrhoeic eczema arises when the skin reacts to natural Malassezia yeasts that live on the skin surface. Those affected often recall scalp dandruff or a scaling rash around their nose, eyebrows or chest.

• I see many patients with inflamed skin triggered by a sensitivity to ingredients in personal skin care products, wet wipes or topical medications, lubricants or agents applied directly, or spread by hands, to the genitals. Such a ‘contact eczema’ rash develops after repetitive use of the culprit product, usually within a few days rather than immediately. It might be difficult to identify a causative ingredient, perhaps when several products are being used, so a dermatologist can arrange patch testing.

Please note, this column is the opinion of the columinst and not that of GNI or Romeo & Julian

So what skin problems can affect your genitals? Pretty-much any skin disorder that can develop on the body can affect the genitals. Nevertheless, some might differ in appearance from other body sites, such as psoriasis which tends to not be as scaly down below, or warts which don’t look like hard lumps as they do on fingers or feet, but more like soft skin

• Lichen sclerosus is a rare disorder that affects the genital skin and patients often describe itch, a burning sensation or a tight sensation with their foreskin movement or vulva, particularly during intercourse. Some experience tearing or bruising of affected skin, which tends to appear pale or white in colour. Under-treated disease can lead to scarring or changes in the appearance of the genitals, however, doctors warn patients to be vigilant and to seek medical attention promptly should bleeding, ulcers or new lumps appear with lichen sclerosus, because there is a small risk of progression to a type of skin cancer.

• Lichen planus, as mentioned earlier, is a rash

• that can affect both the skin and genital mucosal surfaces including the vagina. Mucosal involvement can be very uncomfortable for patients and might require oral therapies in addition to creams and ointments. Patients might also note, or have previously suffered, a rash on their wrists, in their mouth or hair loss.

• Warts are caused by human papillomavirus (HPV) infection, of which there are several subtypes. Hand and foot warts have likely affected most of us at some point in life, however, can spread to the genitals through touch. Treatment is usually by a cream, or a freezing treatment known as cryotherapy. Certain higher risk HPV subtypes can spread via oral or intimate skin contact, whilst others lead to precancerous changes or even genital cancer. Should you ever be concerned that a new lump on your genitals that does not heal, bleeds, causes pain or looks unusual compared to other moles or skin tags, always have this checked early by your GP, a genito-urinary medicine clinic or a dermatologist.

• There are a plethora of lumps and bumps that can affect the genitals, and unfortunately too much to cover in one article, however as mentioned above, always have anything new or changing checked early by your doctor. Skin cysts can arise and perhaps discharge pus. Patients that suffer from a condition known as hidradenitis suppurativa, develop painful cysts and deeper abscesses on the genitals, buttock and other ‘fold’ sites on the body including armpits and under the breasts. This can be difficult to manage and live with, relying on regular antibiotics, special washes and sometimes injectable mediation from dermatology to suppress and control the immune system. Skin tags often affect the groin area and are more common with age, with patients often seeking removal by surgery or cryotherapy for cosmetic purposes. Moles can also affect the penis and vulval skin, but any new pigmented areas should be examined by a doctor. Reassuringly, I see lots of ‘post inflammatory staining’, which is discoloration left behind from a previous rash, and benign genital melanosis, however melanoma cancer can develop on or around the genitals so I would stress that nobody presume, and have new discoloration examined by a doctor early.

My list could go on, however, for now I must finish up and get back to clinic… plus Daniel has me on a word limit! But to put your inquisitive minds at ease; most of these conditions that I see at my genital skin clinic are very easily treated. The main struggle though for my patients who suffer with genital skin problems, is how much their treatment can become an inconvenience or messy. Imagine finding space several times per day to put creams on, then allowing them to dry in. Our groins are naturally warm, then sweat from tight clothing or sitting at a desk all day, can further aggravate itch and discomfort. I write this piece not only to inform you about skin problems affecting the genitals, but also with the hope that you will become more aware and able to empathise with and support any friends, family or intimate partners who develop or are living with a genital skin disorder.

I and my clinical colleagues, plus countless charitable organisations and support groups are here to help and to support you as best we can. For those suffering in silence, please don’t be afraid to reach out and get the conversation, and your treatment journey, started.