A report describes a case of a 39-year-old woman who complained of a feeling of persistent itching, specifically in her fourchette. The patient was not sexually active and was previously diagnosed with psoriasis on her elbows, hairline and feet.

She experienced frequent recurrences, and her treatments involved high potency steroids, both topically and orally, skin moisturizers, coal tar, vitamin D and ultraviolet rays targeted at her lesions. She also got tested for bacterial vaginosis, candidiasis and common STDs, which were all negative. 

The examination revealed a 1.7 cm well-demarcated area in the fourchette between the mucosa and skin, which was erythematous, slightly raised and nonscaly. The patient then identified this as the area of itching.

Her medical history and the clinical presentation of the lesion led to the diagnosis of vulvar psoriasis with a good degree of certainty. The patient declined the biopsy and received advice to wear smooth cotton unscented underwear, to keep the area well moisturized with Astroglide and to use a medium potency steroid ointment. Her condition improved significantly a few days later. 

Like her general psoriasis, she received instruction that the rash on her vulvar site would also reoccur from time to time. The patient came into the clinic a few days later and reported feeling much better.

Source: Manales NJ, Chavez M, Shayeb M, et al. Chronic psoriasis with vulvar presentation: a case report. J Dermatol Res Ther. 2022;8:113.