Understanding Biologic Treatment for Psoriasis of the Groin

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Psoriasis is a chronic skin condition in which red, scaly patches of skin, called plaques, form in different areas of the body. One frequently overlooked but often distressing location that psoriasis plaques can appear is in or around the groin area. This type of psoriasis, also known as genital psoriasis, can be challenging to live with, but fortunately effective treatments are available. As with other types of psoriasis, topical ointments like steroids or vitamin D compounds may be used as a first-line treatment option, but if your genital psoriasis doesn’t adequately respond, ask your doctor about other solutions. A line of treatment known as biologics may be worth exploring.  

What is genital psoriasis?

The most common type of genital psoriasis is called inverse psoriasis. It occurs in the skinfolds, such as between the thighs and groin or in between the buttocks. Genital psoriasis can also be seen:

  • On the genitals

  • Above the genitals

  • On the upper thighs

  • On or around the anus

Genital psoriasis often lacks the thick, scaly appearance of the more commonly recognized plaque psoriasis. Instead, inverse psoriasis generally looks smooth and red or reddish-white in color. Small cracks may be seen in the skin. It may be mistaken for a sexually transmitted disease, yeast infection, or rash.

Most people with genital psoriasis also have psoriasis on other parts of their body, but a small percentage of people will develop psoriasis solely on their genitals. You may feel embarrassed to bring it up to your doctor, but it’s necessary in order to get relief from the itching, burning, and discomfort that occurs along with this condition.

How do biologics work to treat psoriasis of the groin?

We don’t know the exact cause of psoriasis, but researchers think it’s related to an autoimmune response. This means your body’s immune system mistakenly attacks its own tissues, in this case within the skin, causing inflammation and the formation of itchy and painful patches.

Biologics are medications derived from living organisms that alter the way your immune system works. They can block certain enzymes and proteins in your body that cause inflammation, ideally improving your psoriasis in the process.  Biologics are given as an injection (which you may be able to do at home) or as an infusion into a vein.

One biologic, ixekizumab (Taltz), was recently the first to be approved by the U.S. Food and Drug Administration (FDA) as a treatment specifically for genital psoriasis. In a study, patients using ixekizumab reported an overall improvement in their genital psoriasis, symptoms of itchiness, and impact of the disease on their sexual activity. It works by blocking a protein in your body, interleukin-17 (IL-17), that plays a role in the inflammation leading to psoriasis.

There are other biologics to treat psoriasis that act on other parts of the immune system response. There isn’t a lot of data on how these biologics work in direct regards to genital psoriasis, but if you have severe psoriasis that isn’t responding to topical treatments, your doctor may consider you a candidate for one of the following:

  • Interleukin inhibitors: In addition to IL-17, biologics have been developed to inhibit other proteins that also play a role in inflammation, including interleukin 12 (IL-12) and interleukin 23 (IL-23). Ustekinumab (Stelara) and guselkumab (Tremfya) are two examples.

  • Tumor necrosis factor-alpha (TNF-alpha) inhibitors: With psoriasis, your body produces too much of a protein called TNF-alpha. By blocking TNF-alpha production with biologics like etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira), your symptoms can improve.

  • T cell inhibitors: T cells are white blood cells that are involved in the inflammatory process. Abatacept (Orencia) stops T cells from activating.

Are there risks with this type of genital psoriasis treatment?

Because biologics affect your immune system, they can increase your risk of infection. It’s important to let you doctor know if you experience symptoms of infection, such as:

These infections are generally treatable and may require a short break in your biologic therapy, but don’t delay notifying your doctor at the start. Take precautions to avoid getting sick, as well; wash your hands frequently, avoid being around others who are sick, and get your yearly flu shot.
Less commonly, biologics may also cause more serious side effects including:

Before starting a biologic for genital psoriasis, be sure to talk to your doctor about the risks and benefits of your specific treatment. Though biologics have helped many people, they don’t always work for everyone. Some people need to try a few different types of biologics to find what works best to target their inflammation and improve their genital psoriasis symptoms.

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Last Review Date: 2018 Jul 24
  1. Guidelines of care for the management of psoriasis and
    psoriatic arthritis. Journal of the American Academy of Dermatology. https://www.jaad.org/article/S0190-9622(08)00273-9/fulltext
  2. Ixekizumab Effective for Genital Psoriasis, Improves Sexual
    Health. Medscape. https://www.medscape.com/viewarticle/887839#vp_2
  3. Moderate to Severe Psoriasis and Psoriatic Arthritis:
    Biologic Drugs. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/biologics
  4. Psoriasis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
  5. Psoriasis:
    General Principles for Patients Treated with Biologics. American Academy of
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