Female genital eczema

It is important to keep the genital area clean. However, washing the area too much may encourage further irritation, especially if abrasive sponges or flannels are used. Wash with warm water and an emollient soap substitute or your usual leave-on emollient. Avoid soaps, antiseptic washes, moist tissue wipes, bubble baths, deodorants, perfumes, fragrances or any other products that could irritate and dry out the skin. Also, avoid using shampoo in the bath since it could inadvertently come into contact with the genital area and cause irritation. If you do need to shampoo your hair in the bath, apply your emollient to the genital skin first and then rinse it off after you have rinsed your hair. 

Good hand hygiene is important when using emollients and topical steroids – always wash your hands before and after applying treatments. If possible, use emollients from a pump dispenser. If you are using cream or ointment from a pot/tub, do not put your hands in and out of the pot as there is a risk of infection – instead, use a clean spoon or spatula to decant the amount you need to use from the pot. 

Always wipe the genital and perianal area from front to back to avoid infection. Irritant eczema may be worse during menstruation, so use sanitary towels or tampons that are unperfumed, comfortable and do not irritate. You may need to try several products to find ones that suit your skin. 

If you wish to remove hair in the genital area, waxing and shaving products may irritate the skin further. Using your emollient instead of shaving cream may help. 

Comfortable, loose-fitting clothing will help to lessen irritation and friction. It is best to avoid tight trousers and tights – stockings are preferable. Avoid thongs. Underwear made from 100% cotton, bamboo or silk – or at least containing a high proportion of these materials – should be more comfortable, as natural fibres are less likely to irritate the skin.  

Most people with eczema prefer to use a non-biological laundry detergent to wash their clothes. Finding the most suitable one is a case of trial and error. You may find that you need to wash at 60°C or higher for the non-biological detergent to clean your clothing effectively and to remove the grease from emollients. Always ensure that your clothing is rinsed well. It is best to avoid fabric conditioners because they contain fragrance and other ingredients that bind to the clothing fibres to soften them; these might cause irritation or an allergy. 

Most condoms, diaphragms and caps are made from latex rubber and generally do not cause problems for people with eczema. However, some people have an allergy to latex or other rubber ingredients and they should therefore use products made from material such as polyurethane or silicone. 

Spermicides can also irritate the skin. If this is a problem or concern, discuss it with your pharmacist, doctor, or staff at your family planning clinic. 

Emollients and topical steroids can affect the integrity of condoms and diaphragms, so be aware that the effectiveness of these contraceptive methods will be reduced if creams/ointments have been applied recently. 

Personal lubricants (or lubes) are specialised lubricants that help to reduce friction, pain and discomfort during sexual activity. There are many types available and individuals will have different preferences. Water-based lubricants are water-soluble and are the type most commonly used. They do tend to dry out during use, so you may need to reapply them or add water to reactivate them. Silicone-based lubricants are usually formulated with fewer than four ingredients and do not contain any water. Silicone lubricants feel different to water-based ones and, since they are not absorbed by skin or mucus membranes, last longer. 

Emollients can be applied to the genital area as often as required. They should be reapplied after bathing and showering. Use emollients as soap substitutes and avoid all soap and cosmetic washes. It is also a good idea to wash with emollients after opening your bowels to prevent infection when the skin is inflamed (is red or darker than your usual skin tone, depending on skin colour) and sore. Emollients can also alleviate vulval dryness, caused by the menopause. 

Ointment-based topical treatments contain fewer potential allergens than creams, so are especially suitable for sensitive areas. Since ointments are greasy, they spread easily and are well-absorbed. However, creams are easier to spread on hair-bearing skin. 

When using a topical steroid, leave a gap of 20-30 minutes between applying it and an emollient. This is to avoid diluting the topical steroid or transferring it to areas where it is not needed. It does not matter which is applied first. 

Try to apply the topical steroid at the opposite time of day to when you usually have sex.