engleski

Anogenital contact dermatitis

Soreness, irritation and itch of the genitals and/or the perianal skin are frequently encountered in clinical practice. In most cases an infective cause or common dermatosis can be identified. Where these are absent, the possibility of an irritant or allergic contact dermatitis (ACD) should be considered. Anogenital skin is susceptible to irritant dermatitis because of persistent occlusion, sweating, friction and exposure to vaginal/urethral secretions. Genital ACD can present acutely with erythema and erosions or chronically with pruritus and lichenification. Genital allergy is an uncommon and likely an underdiagnosed condition as patients oftentimes refrain from reporting symptoms in this area and tend to self-treat with over-the- counter topical preparations, which can lead to exacerbation or further delay in proper diagnosis. Diagnosis of genital contact dermatitis may be also delayed by the presence of other genital dermatoses, which can predispose the skin to barrier dysfunction, irritant dermatitis and allergen penetration. Associated impairment of quality of life can be severe, with patients experiencing dyspareunia, persistent burning sensation or even disturbance of sleep due to pruritus. Genital hypersensitivity reactions may be subdivided into those that are related to sexual activity and those that may occur in the absence of sexual contact. Patch testing is a valuable tool in assessing patients with protracted anogenital symptoms, especially if there is no response or a worsening of symptoms to the application of topical steroids. Studies have reported rates of ACD up to 63% in patients with anogenital symptoms, and on the other hand, a delay to presentation of 5.5 years from onset of symptoms. Therefore, ACD seems to be more likely present in patients with symptoms lasting for more than 5 years and those using multiple products. Sources of ACD can be present in anti-hemorrhoidal creams, cleansing wipes, washes, and freshening sprays, spermicidal preparations, rubber products including condoms and topical medications. Commonly encountered allergens are local anesthetics, corticosteroids, fragrances, Balsam of Peru, stabilizer sodium metabisulfite, antibiotics and methylisothiazolinone. Once an allergen has been identified, avoidance is the optimal approach to management.

contact dermatitis ; patch test ; genital diseases

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