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 may contain harsh substances that disrupt the natural balance of the vaginal flora, thereby causing irritation. Similarly, feminine hygiene products, such as scented tampons, or wearing underwear that is too tight, can cause irritation when they come into direct contact with the delicate skin of the intimate area. In some individuals, these repeated irritations may promote the development of vulval dermatitis or eczema of the intimate area, particularly when the skin barrier is already compromised, although this is not always the case.

Irritation can also manifest as a yeast infection. These occur frequently when the vaginal environment is out of balance and certain populations of micro-organisms living there become over-represented. To prevent them, it is preferable 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 characterised by discomfort and itching and may affect different parts of the body, including the intimate areas, such as the labia, the pubic region or the perineal zones. In such cases, the terms vaginal eczema, eczema of the vagina, or more broadly eczema of the intimate areas may be used, depending on the site and the symptoms observed.

Whatever the cause of this irritation, if it does not clear up naturally within a few days, it is important to consult a healthcare professional so that they can determine its origin and prescribe an appropriate treatment to relieve it.

In some cases, itching of the vulva is linked 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 responsible. It is also possible for vulvar eczema to be atopic in origin, meaning related to a genetic predisposition in the individual and to very sensitive skin. However, this form of eczema is less common.

Vulvar eczema manifests as 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, in which case this is referred to as groin fold eczema. The symptoms are then similar to those of eczema affecting the folds of the legs and arms.

It is, however, important to note that the symptoms of eczema are similar to those of other skin conditions such as psoriasis or fungal infections. A mycosis, for example, can also cause itching, redness and localised discomfort, which sometimes makes diagnosis difficult. This is why a differential diagnosis must be carried out by a doctor to confirm whether it is indeed 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 identify precisely the responsible allergens.

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

Genital eczema in men may 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, the inflammation can be exacerbated 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 intimate washing gels, and detergent residues left on underwear. More rarely, an atopic predisposition may be involved. As in women, a precise diagnosis is essential in order to distinguish eczema from other skin conditions that may affect the genital area.

As soon as symptoms of eczema in the intimate areas appear, it is recommended to consult a doctor 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 pathologies. When the 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 textile or a chemical substance.

In cases of eczema affecting the intimate areas, topical corticosteroids, that is to say creams based on cortisone, are often prescribed for a limited duration. They help to rapidly reduce skin inflammation, notably by inhibiting the release of pro-inflammatory cytokines and limiting the activation of immune cells involved in the eczematous reaction. Their use must, however, remain 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 soothe sensations of discomfort. This step is essential, as an impaired skin barrier promotes the penetration of irritants and perpetuates the inflammatory cycle.

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

It is advisable to favour gentle, fragrance-free cleansing products that respect the physiological pH of the intimate area, so as not to disrupt the local microbiota. Wearing cotton underwear, which is less occlusive, also helps to reduce humidity and friction, two aggravating factors for eczema. Finally, avoiding products that are potentially irritating or allergenic is a key measure for maintaining long-term skin balance.

• 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).