What Is Genital Psoriasis?
Genital psoriasis is a type of psoriasis (a skin condition) 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 as well.
Genital psoriasis isn't a sexually transmitted disease (STD), and it's not contagious. 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 ease your symptoms and lead to healthier skin.
Genital psoriasis vs. herpes
These two conditions can cause similar symptoms. Genital psoriasis is an autoimmune condition, and you can't get it through sexual contact. Genital herpes is a sexually transmitted infection caused by a virus. Herpes sores start as small clusters of blisters. They may break open and ooze fluid. As the sores heal, scabs may form. You may have flu-like symptoms, such as headache, fever, exhaustion, and muscle pain. Over time, your symptoms with each outbreak may become milder. Pain or tingling in your genitals can be an early sign of an outbreak. To make a diagnosis, your doctor may have to take a sample of the affected area and have it checked by a lab for the herpes virus. It's not always possible to tell what's causing a rash just by looking.
Genital psoriasis vs. jock itch
When you have jock itch, you have a flat, red, scaly rash that's very itchy. Jock itch is caused by a fungal infection. The fungus likes warm, moist skin, which is why it's common in the genital area. It's also called tinea cruris. Unlike psoriasis, jock itch is contagious. You can get it from contaminated clothing or towels. Because it's caused by the same fungus as athlete's foot, you also can spread it by touching your feet and then your groin. Jock itch spreads outward, often in a ring-like shape, and the center may start to clear up even as the rash is spreading.
Types of Genital Psoriasis
There are two types of psoriasis that commonly affect genital areas.
Inverse psoriasis
If you have inverse psoriasis, your skin will be discolored and smooth, not scaly. It may look like it's stretched tight. The area might be painful and itchy, and your skin might split open. Sweat can make it worse. It also might become more irritated if it's located in areas where your skin rubs against clothes or other parts of your body. In addition to your genitals, inverse psoriasis can show up under your arms, under your breasts, or in other folds of your skin.
Plaque psoriasis
When you have plaque psoriasis, you'll have patches of thickened skin. On lighter skin tones, the plaques will look red. On darker skin tones, the patches might be purple, gray, or dark brown. You might see a buildup of dead skin cells on top that are lighter in color. These areas might be painful and itchy, and your skin might crack. Plaque psoriasis can show up on your knees and elbows, scalp, and torso in addition to your genitals.
Genital Psoriasis 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 ones are:
- Infections
- Skin injuries
- Being overweight or obese
- Smoking
- Heavy drinking
- Stress
- Certain medicines
- Cold weather
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.
Genital Psoriasis Symptoms
You can have psoriasis on your genitals and nearby places, such as your:
- Pubic area
- Upper thighs
- Creases between your thighs and groin
- Anus and the crease between your buttocks
Psoriasis in these areas often looks different. Patches of inverse psoriasis are often bright red, smooth, and shiny. You usually don't see silvery scales because they rub off when you move.
You may have gray, scaly plaques on your vulva, just outside the vagina. But patches in skin folds are often glossy red.
Small red patches can appear on the shaft or tip of your penis. Scaly patches are more common when you're circumcised.
Because these areas are so sensitive, psoriasis symptoms feel more intense. They include:
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 on 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.
Genital Psoriasis 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, genital herpes, 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 talk with your doctor, you may have many questions. They might include:
- 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?
Genital Psoriasis 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.
Treatments for genital psoriasis include:
Nonsteroidal cream. Your doctor may prescribe a topical that contains ingredients other than steroids to treat your psoriasis, such as tapinarof (Vtama) or roflumilast (Zoryve).
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 make your skin even thinner and cause stretch marks and broken blood vessels if you use it for too long.
Your doctor probably will 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 such as 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 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 if you also have it on other parts of your body.
Medications such as 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 proteins that impact your immune system. They are injected or given by IV in your doctor's office:
- Adalimumab (Humira)
- Brodalumab (Siliq)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Guselkumab (Tremfya)
- Infliximab (Remicade)
- Ixekizumab (Taltz)
- Risankizumab (Skyrizi)
- Secukinumab (Cosentyx)
- Tildrakizumab-asmn (Ilumya)
- Ustekinumab (Stelara)
Retinoids such as acitretin (Soriatane), which are man-made vitamin A, may help control how fast skin cells grow and are shed.
Apremilast (Otezla), deucravacitinib (Sotyktu), and tofacitinib (Xeljanz) are pills you take to interrupt the inflammation process in cells.
Sometimes, a combination of medicines works best.
Genital Psoriasis Home Treatment
People with psoriasis often look for alternative approaches to managing symptoms. They can include:
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 milk 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, such as red meat, sugar, dairy, and processed foods, are not allowed. 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. That means no bread, pizza, rolls, cakes, cookies, pies, and beer. Gluten is also hidden in hundreds of products you'd never think of, such as soy sauce and tomato paste, so you need to read labels carefully.
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, but 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 such as 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 hurt 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 such as 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. They 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, such as meditation, yoga, or listening to music.
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 contagious and doesn't spread through kissing, hugging, or sex.
Because 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
Many groups offer help and support to people with psoriasis. The National Psoriasis Foundation is a good place to start. Contact its 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.
Takeaways
Genital psoriasis is a skin condition caused by a problem with your immune system. It's not a sexually transmitted infection, and you can't get it from or spread it to someone else. If you have it, your genital area will have patches of skin that can be itchy and painful. Genital psoriasis can be difficult to deal with, but several treatments are available. They include topicals you put on your skin and medicines you take in pill form, by injection, or through an IV. You may need a combination of treatments. Steps you can take at home -- including moisturizing your skin and changing your diet -- also can ease symptoms.
Genital Psoriasis FAQs
What does genital psoriasis look like?
If you have inverse psoriasis -- the most common type affecting genitals -- your skin may look stretched and tight. It will be discolored and smooth, not scaly. If you have plaque psoriasis, which is less common in the genital area, you'll have thick patches of skin. Depending on your skin tone, the patches might look red, purple, dark brown, or gray. These patches may have scales of dead skin on top.
What causes genital psoriasis to flare up?
Many things can cause psoriasis to flare, including stress, certain medicines, other illnesses, and even cold weather. Specific triggers for genital psoriasis include:
- Friction from tight clothes or sexual contact
- Injuries to your skin
- Yeast infections
What can be mistaken for genital psoriasis?
Genital psoriasis can cause symptoms that resemble eczema, jock itch and other fungal infections, genital herpes, and a rare type of skin cancer.
What are over-the-counter (OTC) treatments for genital psoriasis?
Some OTC products can help ease symptoms of psoriasis, but the strongest medicines require a prescription. Some people find that products containing coal tar or hydrocortisone improve symptoms. These ingredients also can irritate the skin, so be careful. Products that contain calamine, camphor, hydrocortisone, or menthol may give you some relief from itching. But they also can dry your skin. There's no downside to using a moisturizer, which can ease dryness and help your skin heal. Choose an ointment, heavy cream, or oil rather than lotion. And make sure the product you use is free of alcohol and added fragrance. Bear in mind that the skin in your genital area is more sensitive than other parts of your body.
