Genital Psoriasis: An In-Depth Guide

What Is It?

Genital psoriasis is a type of the skin condition psoriasis that you get on or around your genitals. Sometimes that may be the only place you have it. But many people have itchy, red patches on other parts of their body at the same time.

Genital psoriasis isn't an STD, and it's not catching. But it can change the way you feel about your body and put a damper on your love life. It's also more uncomfortable and harder to treat than other types of psoriasis.

If you think you have genital psoriasis, talk to your doctor. It can't be cured, but treatment can relieve your symptoms and lead to healthier skin.

Causes

When you have psoriasis, your skin cells grow much faster than normal. Your body can't get rid of them all, so they build up in scaly, red patches.

This mainly happens because there's a problem with your immune system. Normally, your immune system attacks germs that can make you sick. When you have psoriasis, it makes a mistake and attacks healthy skin cells.

Genes you inherit may also play a role. But having psoriasis in your family doesn't mean you'll get it, too. Some people who have psoriasis genes never have skin problems. And many people have psoriasis but not the genes that can cause it.

One thing's for sure. You don't get psoriasis unless something triggers it. Triggers aren't the same for everyone. Some of the most common are:

These same things can also cause flare-ups of psoriasis you already have. Recognizing and learning how to manage your triggers can help improve your symptoms and lead to fewer flares.

Symptoms

You can have psoriasis on your genitals and nearby places like your:

  • Pubic area
  • Upper thighs
  • Creases between your thighs and groin
  • Anus and crease between buttocks

Psoriasis in these areas often looks different. Patches of inverse psoriasis, the most common type in the genital area, are often bright red, smooth, and shiny. You usually don't see silvery scales because they rub off when you move.

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Women may have gray, scaly plaques on their vulva, just outside the vagina. But patches in skin folds are often glossy red.

Men can get small red patches on the shaft or tip of their penis. Scaly patches are more common when you're circumcised.

Because your privates are so sensitive, psoriasis symptoms feel more intense.

Itching. A lot. For many people, it's the worst part of the disease. It can keep you up at night and get in the way of being intimate. You might even scratch until you bleed. This can set up a cycle of more itching and bleeding.

Burning and stinging. Genital psoriasis can feel like putting a hot match to your skin. Sweat, heat, and friction make this feeling worse.

Pain. It isn't always painful, but it is hard to ignore. The more you move or sweat, the more irritated your skin gets. Exercise, sports, and sex make symptoms worse. For some people, even sitting still can hurt.

Infections. Thin, delicate skin can crack open and bleed. That sets the stage for bacterial or fungal infections. If you think you have an infection and psoriasis at the same time, tell your doctor. You may need two different treatments.

Getting a Diagnosis

There's no test for psoriasis. Most of the time, your dermatologist can diagnose it just by looking at your skin.

But genital psoriasis can look like and feel like other rashes, including eczema, yeast infections, and even a rare form of skin cancer. If your doctor's not sure, they may take a small skin sample called a biopsy and have it checked in a lab.

Questions for Your Doctor

Once you have "the talk" with your doctor, you're likely to want answers.

  • Why did I get this? Did I do something to cause it?
  • Can my romantic partner catch it?
  • Will sex make it worse?
  • Can I even have sex?
  • Will it go away on its own?
  • Is there a cure?
  • Are there treatments? How well do they work? What are the side effects?
  • If I start treatment now, how long until it gets better?
  • What can I do to stop this itching?!

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Treatment

Genital psoriasis is tough to treat. The first medicine you try might not help. Tell your doctor if it's not working, your skin burns or stings when you put something on it, or you get an infection.

Even if you're doing fine, it's important to check in with your doctor. Some treatments are too strong for delicate skin and shouldn't be used for the long term.

Low-dose steroid cream: Doctors often prescribe this first because it's one of the best treatments for psoriasis. But you have to use steroids with care. Thin skin absorbs medicine more easily, so you're more likely to have side effects. Steroid cream can also make your skin even thinner and cause stretch marks and broken blood vessels if you use it for too long.

Your doctor will likely prescribe a low-dose steroid cream only for a very short time or to treat a flare.

Mild vitamin D creams: These have fewer long-term side effects than steroids, and you can use them longer. Sometimes they're mixed with a mild steroid to make it less irritating. Not all vitamin D creams are good for sensitive skin, so only use the one your doctor prescribes.

Calcineurin inhibitors: Two medicines you put on your skin -- pimecrolimus (Elidel) cream and tacrolimus (Protopic) ointment -- normally treat skin problems like eczema. But they can also work for genital psoriasis.

These medicines don't have steroids, so they're safe to use on your penis and vagina. Expect some stinging and burning when you first put them on.

Dapsone (Aczone): Doctors use this antibiotic gel to treat acne and leprosy. Your doctor may try it for psoriasis when other treatments haven't worked. Dapsone can cause anemia and other side effects, especially when you take it as a pill, so you need to have blood and liver tests while using it.

Systemic medicines: These are strong drugs that can affect your whole body, not just your skin. Your doctor may prescribe them if your psoriasis is very severe or not well-controlled, or you have it on other parts of your body, too.

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Medications like cyclosporine and methotrexate that slow down your immune system have been around for decades. They can have serious side effects, such as kidney or liver problems, especially if you take them for a long time.

Biologics are newer drugs that target very specific things about the way your immune system works. You get them through a needle, either a shot you can give yourself or an IV in your doctor's office.

Retinoids like acitretin (Soriatane), which are man-made vitamin A, may help control how fast skin cells grow and are shed.

Apremilast (Otezla) is a pill you take to interrupt the inflammation process in cells.

Sometimes, a combination of medicines works best.

Complementary Treatments

People with psoriasis often look for treatments that work better and have fewer side effects.

Moisturizer: This is a key part of daily care for psoriasis on your whole body, including sensitive areas. A lighter texture is better for delicate skin. Use cleansing milks or oils instead of soap to wash your face and body.

Be sure all products you use are fragrance- and alcohol-free. Lots of personal care items can cause allergies or a flare.

Weight loss: One sure way to improve psoriasis is to drop extra pounds. Being overweight makes your symptoms worse and harder to treat. Most people who shed even a little weight feel better and have clearer skin.

Mediterranean diet: On this plan, you mainly eat fresh vegetables, fruit, fish, and olive oil and can enjoy a little red wine. Foods that cause inflammation like red meat, sugar, dairy, and processed foods are out. Besides helping your skin, this way of eating is great for your overall health.

Gluten-free diet: Many people see a big improvement in their skin when they cut out gluten, a protein found in wheat, rye, and barley. Basically, that means no bread, pizza, rolls, cakes, cookies, and pies -- and beer. Gluten is also hidden in hundreds of products you'd never think of, like soy sauce and tomato paste, so you need to read labels carefully.

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Stay completely gluten-free for at least 3 months before you decide whether it's working for you.

Fish oil: It's rich in two crucial omega-3 fatty acids, called EPA and DHA. Not only does your body need them, they may also lower high levels of fat in your blood and help ease arthritis pain. For many people, they relieve dry, itchy skin.

You can get omega-3s by eating fatty fish like salmon and sardines. Or you can take fish oil in a pill. But if you take blood thinners or have seafood allergies, talk to your doctor first.

Taking Care of Yourself

Dealing with any skin problem is hard. When the problem's on your genitals, it can seem 100 times worse. Genital psoriasis can chip away at your self-confidence. It can also make sex painful and create stress between you and your partner.

But psoriasis doesn't have to stand in the way of a healthy and satisfying life.

Show your skin some love. Choose looser clothes and undies that are silk, linen, or cotton. Synthetic fabrics like nylon and polyester hold in heat and can stick to dry, cracked skin.

Good-quality toilet paper will help prevent flare-ups, too.

Shower off sweat quickly. Try to keep showers lukewarm and under 10 minutes so they don't dry out your skin. Apply a natural cream or oil while your skin's still damp. (Olive oil may be a good choice for your tender skin.)

Use lubricants during sex. Lubes help cut down on the friction that can make sex painful. Be sure to choose one labeled "cooling." These usually have mint and other soothing herbs. Warming lubes often use hot peppers and spices that could trigger flares. Or make your own lube with coconut oil. It keeps skin moist and may calm burning and itching.

A lubricated condom cuts down on irritation, too. Look for non-latex ones; some treatments for genital psoriasis can cause latex condoms to leak or break.

Break the stress cycle. Having psoriasis is stressful, and stress makes psoriasis symptoms worse. Try to find healthy ways to de-stress, like meditation, yoga, or listening to music.

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If you're having trouble accepting psoriasis as part of your life, consider counseling or therapy. It can build your self-esteem and confidence and give you a sense of control. It might also make it easier to talk to your partner(s) about sex.

Keep the lines of communication open. Be open and honest with your partner. If you're in a long-term relationship, talk about ways to make sex more comfortable for both of you. If you're with someone new, be upfront about your psoriasis. Explain that it's not catching and doesn't spread through kissing, hugging, or making love.

Since psoriasis around your groin and genitals can look like an STD, you may need to reassure your partner that it isn't an infection. (Can't answer all your partner's questions? Invite them along on your next doctor visit.)

When you're having a flare or sex is too painful, say so. Sex is only one part of intimacy. Explore other ways of touching and being together instead. Bonus: That could make the sex even better the next time around.

Getting Support

Lots of groups offer help and support to people with psoriasis. The American Psoriasis Foundation is a good place to start. Contact their Patient Navigation Center for more information on genital psoriasis and doctors who treat it. Or check out the American Academy of Dermatology's Psoriasis Resource Center.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on July 24, 2018

Sources

SOURCES:

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Journal of Dermatological Treatment: "Prevalence of genital psoriasis in patients with psoriasis."

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"Psoriasis Information: Sensitive Areas," Psoriasis Association, October 2016.

National Psoriasis Foundation: "Inverse Psoriasis," "The Immune System and Psoriatic Disease," "Does Obesity Lead to Psoriasis?" "About Psoriasis," "Gluten-Free Diet," "Psoriasis and intimacy."

American Academy of Dermatology: "Psoriasis: Diagnosis, treatment, and outcome," "Psoriasis: Who gets it and causes."

Psoriasis: Targets and Therapy: "Drug-induced psoriasis: clinical perspectives."

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