Use and misuse of topical corticosteroid in genital dermatosis

Abstract

Many a time topical corticosteroids are prescribed for genital dermatosis of diverse etiology without establishing a definite cause because of its potent anti-allergic and anti-inflammatory effect. Due to its microenvironment, drug penetration in genitocrural region is highest in the body and hence, it is more susceptible to the adverse effects of topical corticosteroid. The absorption quotient of the scrotum is found to be 40 times that of the forearm. In females, poor sensory discrimination, overlapping symptomatology and high anatomic variability of the vulval skin may obscure the unwarranted side effects of steroids. The post-menopausal vulva is particularly susceptible to the side effects of topical agents. Topical corticosteroids are useful in conditions like balanoposthitis, plasma cell balanitis/zoon's balanitis, lichen sclerosus et atrophicus, balanitis xerotica obliterans, plasma cell vulvitis and contact dermatitis. Genital pruritus can be due to diverse causes and it is essential to find out the exact cause so that unnecessary use of topical corticosteroid is minimized. Alternatives to steroid should be considered like use of calcineurin inhibitors, tacrolimus and pimecrolimus 1%. In many inflammatory dermatoses, circumcision should be advised as first line measure so that prolonged use of corticosteroid can be avoided.