Irritation of the intimate area: could it be vulvar eczema?

Irritation of the intimate areas can be caused by many factors and is not necessarily a sign of eczema.

Perfumed hygiene products and soaps can contain harsh substances that disrupt the natural balance of the vaginal flora, leading to irritation. Similarly, feminine hygiene products, such as scented tampons, or wearing underwear that is too tight, can cause irritation when they are in direct contact with the delicate skin of the intimate area. In some people, these repeated irritations can promote the development of vulvar dermatitis or eczema of the genital area, especially when the skin barrier is already weakened, although this is not always the case.

Irritation can also manifest as a yeast infection. These infections occur frequently when the vaginal environment is out of balance and certain populations of the microorganisms that live there become overrepresented. To prevent them, it is best to choose cotton underwear that is loose enough to allow air to circulate.

Finally, irritation of the intimate areas may be caused by a dermatosis, such as psoriasis or eczema. Both of these skin conditions are characterized by discomfort and itching and can affect different parts of the body, including the intimate areas, such as the labia, the pubic region, or the perineal areas. In such cases, people sometimes refer to vaginal eczema, eczema of the vagina, or more broadly, eczema of the intimate areas, depending on the location and the symptoms observed.

Regardless of the cause of these irritations, if they do not go away on their own after a few days, it is important to consult a healthcare professional so they can determine their origin and prescribe an appropriate treatment to relieve them.

In some cases, itching in the vulvar area is related to vulvar dermatitis. This condition is often caused by contact between the intimate area and allergens. These may come from intimate creams, soaps, underwear, or even the latex in condoms. Products applied to the hands that then come into contact with the genital area may also be involved. It is also possible for vulvar eczema to be atopic in origin, meaning it is linked to a genetic predisposition and very sensitive skin. However, this type of eczema is less common.

Vulvar eczema is characterized by the appearance of red patches covered with small vesicles on the vulva and at the entrance to the vagina.

When the person scratches, these lesions rupture, causing oozing and leading to the formation of scabs. It is also possible to develop eczema in the groin folds; this is then referred to as groin-fold eczema. The symptoms are similar to those of eczema affecting the folds of the legs and arms.

It is nonetheless important to note that the symptoms of eczema are similar to those of other skin conditions such as psoriasis or fungal infections. A fungal infection, for example, can also cause itching, redness, and localized discomfort, which can sometimes make diagnosis challenging. This is why a differential diagnosis must be made by a physician to confirm whether it is truly vaginal eczema or another condition. This diagnosis is based on a medical history and a clinical examination. If contact eczema is suspected, patch tests may be performed in order to precisely identify the responsible allergens.

While vulvar and vaginal eczema are common in women, men can also be affected by this type of skin condition. In that case, it is referred to as eczema of the male intimate areas, which can involve different genital regions. Penile eczema is particularly common and appears as red patches on the male genital organ, sometimes accompanied by dryness or flaking. These lesions can also spread to the pubic area, in which case the condition is referred to as pubic eczema in men, or they may affect the groin folds, areas that are particularly exposed to friction and moisture.

Genital eczema in men can also affect other areas, such as the testicles, in which case it is referred to as testicular eczema. The symptoms are similar to those observed in women, with itching, burning sensations, and sometimes oozing lesions in cases of scratching. As with pubic eczema or flexural eczema, inflammation can be worsened by sweating and occlusion, which makes these areas particularly sensitive.

Eczema of the intimate areas in men is most often related to contact eczema, triggered by exposure to irritating or allergenic substances.

Among the most frequent causes are the latex in condoms, certain cleansing gels, and detergent residues on underwear. Less commonly, an atopic predisposition may be involved. As in women, a precise diagnosis is essential to distinguish eczema from other skin conditions that can affect the genital area.

As soon as symptoms of eczema in the intimate areas appear, it is recommended to consult a physician promptly.

The latter will be able to make an accurate diagnosis in order to identify the origin of the lesions, whether they are due to contact eczema, atopic eczema, or another skin condition. This step is essential for tailoring management and avoiding confusion with other diseases. When eczema is linked to an allergen or an irritant, the first measure is to eliminate the triggering factor, whether it is a hygiene product, a fabric, or a chemical substance.

In cases of eczema affecting the intimate areas, topical corticosteroids, that is, creams containing cortisone, are often prescribed for a limited duration. They help to rapidly reduce skin inflammation by inhibiting, among other mechanisms, the release of pro-inflammatory cytokines and limiting the activation of immune cells involved in the eczematous reaction. Their use must, however, be carefully monitored, particularly in these areas where the skin is thinner and more permeable.

In parallel, the regular application of emollients plays a central role. These treatments help restore the skin’s barrier function by supplying lipids similar to those naturally present in the stratum corneum. In this way, they limit transepidermal water loss, reduce skin dryness, and relieve sensations of discomfort. This step is essential, because an impaired skin barrier promotes the penetration of irritants and perpetuates the inflammatory cycle.

In daily life, a few adjustments can also help reduce the risk of recurrence.

It is recommended to prioritize gentle, fragrance-free cleansing products that respect the physiological pH of the intimate area, in order not to disrupt the local microbiota. Wearing less occlusive cotton underwear also helps reduce moisture and friction, two factors that can worsen eczema. Finally, avoiding products that may be irritating or allergenic is a key measure to preserve skin balance over the long term.

• GOLDENBERG G. & al. Eczema. The Mount Sinai Journal of Medicine (2011).

• BORRADORI L. & al. Dermatologie et infections sexuellement transmissibles. Elsevier Masson (2017).

• PICHARDO-GEISINGER R. Atopic and contact dermatitis of the vulva. Obstetrics and Gynecology Clinics of North America (2017).

• HYUN CHO S. & al. Real-world prevalence and burden of genital eczema in atopic dermatitis: A multicenter questionnaire-based study. The Journal of Dermatology (2021).

• BERNABEU-WITTEL J. & al. Vulvar dermatoses: A cross-sectional 5-year study. Experience in a specialized vulvar unit. Anais Brasileiros de Dermatologia (2022).