How to Treat and Care for Genital Psoriasis
If you’ve been dealing with psoriasis for a while, you know exactly how uncomfortable a flare can be. The itching, the scaling, the pain—they’re not symptoms anyone looks forward to. But when a psoriasis flare is on the sensitive skin of the genital area, that discomfort can be amplified. There are other potential problems, too, including embarrassment, slow improvement, and interference with one’s sex life. But treatment can help, as can self-care.
Here, we’ve answered the most common questions about living with genital psoriasis.
What Is Genital Psoriasis?
The term simply refers to the area of the body where the psoriasis appears, says Anna Chacon, M.D., a board-certified dermatologist at the Cleveland Clinic Florida, Weston Hospital.
“Genital psoriasis occurs when there are psoriatic skin lesions or plaques in the groin, genitalia, or buttocks,” Chacon explains. It can be any type of psoriasis, including plaque psoriasis, which is the most common form, and inverse psoriasis, which appears in skin folds such as the groin and armpit.
While plaque psoriasis is typically characterized by thick, rough plaques, inverse psoriasis can be quite smooth.
“Since these areas are hidden and harbor moisture, the skin may appear red and shiny, instead of flaky, and may sometimes have a white film,” explains Sharleen St. Surin-Lord, M.D., a board-certified dermatologist and founder and medical director of Visage Dermatology and Aesthetic Center in Largo, Maryland.
Who Gets Genital Psoriasis?
The National Psoriasis Foundation says that up to two-thirds of people with psoriasis will experience genital psoriasis. And most people with genital psoriasis also have psoriasis elsewhere on their bodies.
“Genital psoriasis can affect any patient population,” Chacon says. “It affects both men and women, and both children and adults.”
In children and infants, she says the condition commonly appears prior to the age of 2, when diapers are consistently used and the moisture in the genital area can contribute to flares. “In these patients, it is commonly confused with diaper rash,” she says.
No matter what age you are, unfortunately, the condition is often overlooked by physicians, according to a report in the American Journal of Clinical Dermatology. This is despite the fact that genital psoriasis can have a significant impact on mental health.
What’s Different About Genital Psoriasis?
Psoriasis in the genital area may burn more than it itches, and people with the condition often complain of genital pain. Plus, these flares can sometimes be harder to treat due to the moisture in the affected areas.
“Many patients wonder why they’re taking so long to respond to therapy,” St. Surin-Lord says. “Some say it itches incessantly.”
Pain in the sensitive genital region is never fun. But Chacon says genital psoriasis patients have other complaints, as well, including scaling from psoriatic plaques and embarrassment.
Often, there’s a “feeling like you cannot have a normal sex life or acceptable quality of life,” Chacon says.
What About Sex?
If someone is experiencing genital pain or eroded skin in the genital area, sex may be a less pleasurable experience.
“Having red, inflamed, or flaking skin on the genitals may lead someone to refrain from intimate contact for fear of being judged or having their psoriasis mistaken for a sexually transmitted infection,” says St. Surin-Lord.
Also, the risks for contracting an STI can also go up when a person is experiencing an active flare, according to St. Surin-Lord. This is because the psoriasis lesions compromise the skin’s integrity.
Research published in the Journal of the American Academy of Dermatology found that 42 percent of people with genital psoriasis report pain during sex, and 32 percent report a worsening of symptoms when engaging in sex. As a result, 43 percent of genital psoriasis sufferers experience a decrease in their frequency of sex, specifically because of their condition.
All of this is just further reason to talk to your doctor about the symptoms you’re experiencing, and to work together to find a treatment that can help.
What Treatments Are Available?
St. Surin-Lord says the mainstay treatment for genital psoriasis is topical therapy.
“This normally involves topical steroid creams and ointments,” she explains, adding that, “Ointments tend to be less irritating and more soothing since they are oil-in-water formulations without preservatives.”
Creams and foams can sting in these sensitive areas, St. Surin-Lord says. And steroids tend to be used judiciously because of the side effects (such as thinning skin, skin lightening, and an increase in stretch marks) that can result if they are used for too long.
“There are also calcipotrienes, which are a man-made form of Vitamin D3,” St. Surin-Lord explains. “These work by slowing the excessive production of skin cells to prevent flaking. They also offer a break from topical steroid preparations.”
For people whose genital psoriasis is difficult to manage, St. Surin-Lord says that biologic treatments may prove beneficial. Ultraviolet (UV) light therapy, which is sometimes used to treat psoriasis, isn’t as likely to be used for genital psoriasis, since exposing these areas to UV light may increase the risk of squamous cell cancer, she adds.
All of these factors will be taken into consideration when you and your doctor work together to create a genital psoriasis treatment plan.
“Treatment of genital psoriasis is provided on a case-by-case basis, as it varies,” Chacon says. “There is limited published data for efficacy and safety of treatment options.” So, doctors do the best they can, working with what they know about a patient’s individual health history and lifestyle.
Can I Prevent Flare-Ups?
Most people with psoriasis will tell you that sometimes you can do everything right, and a flare will still happen. But there are ways to reduce the risk of a flare and keep the skin in the genital area as healthy as possible.
First, you can wear breathable underwear made from cotton or bamboo. This will help you avoid moisture accumulation, which can be irritating, says St. Surin-Lord. Of course, sweat is one of those potentially irritating types of moisture, but that doesn’t mean you should stop working out.
“Since exercise is an excellent way to reduce stress, and psoriasis can be flared by stress, we want patients to exercise,” says St. Surin-Lord. Just be sure to change out of sweaty or damp undergarments as soon as possible after your workouts.
The American Academy of Dermatology further suggests using mild, fragrance-free cleanser, and splurging on good quality toilet paper, which is usually gentler on skin.
If possible, try to change positions often. “Prolonged sitting, or performing any activity for an extended period of time, may also worsen psoriasis,” Chacon says, pointing out that trauma or friction to the skin caused by repeated movements or prolonged contact may lead to a flare, and should therefore be avoided.
When Should I See a Doctor?
While it can be uncomfortable to discuss a genital problem, both St. Surin-Lord and Chacon agree that people experiencing genital psoriasis should see their doctors as early as possible.
“Although it may be uncomfortable to discuss with your doctors, patients who seek advice can achieve control of their disease and have a great quality of life,” Chacon explains.
But improvement can only happen if you pick up the phone and call your doctor’s office first.