When Psoriasis Is Only Severe in Intimate Areas

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Psoriasis is a chronic skin condition that accelerates the growth cycle of skin cells. As the body produces skin cells at a rapid rate, it doesn’t have time to slough off the old cells. The cells begin to pile up on the surface of the skin, causing thick lesions to develop.

Psoriasis can develop almost anywhere on the body. It can appear on the scalp, elbows, and knees, as well as the genitals, buttocks, and the upper thigh area. In some people, the symptoms are most severe in the genital area. Psoriasis can show up on the penis and the vulva, as well as the anus and surrounding area. You might have the rest of your psoriasis under control, but genital psoriasis sometimes requires different treatments and strategies to reduce symptoms.

Severe psoriasis in intimate areas can cause embarrassment, and even distress and anxiety. Unfortunately, psoriasis can’t be cured. But it can be well managed, even in the genital area.

Determine Your Diagnosis

Two types of psoriasis can affect the genital area: plaque psoriasis and inverse psoriasis. Fungal and bacterial infections can occur in the same area, so it’s important to know what you’re dealing with in order to identify how to best treat and care for yourself.

  • Plaque psoriasis: Plaque psoriasis is what most people think of when they think of psoriasis. It typically causes red, scaly patches to develop. The patches aren’t always scaly when they develop in the genital area, however. They could be scaly red patches along the shaft and tip of the penis, but they might be smooth red patches on the vulva.

  • Inverse psoriasis: Instead of thick, red patches of skin, inverse psoriasis tends to cause smooth, greyish-red or reddish-white lesions in the folds of the skin, like between the buttocks and the crease where the upper thigh meets the groin. They can be very painful. They can also crack and bleed, which raises the risk of developing an infection there. Inverse psoriasis is rarer overall than plaque psoriasis, but it tends to occur much more often in intimate areas of the body.

Find the Best Treatment

The right diagnosis will allow you to pursue the best treatment. The goal of treatment is to reduce the itching and pain and clear up the psoriasis lesions as much as possible.

Treatment for plaque psoriasis is usually very similar to treatment for inverse psoriasis. Howevever, treatment can vary depending on the severity of the symptoms. The first line of treatment is usually a topical cream or ointment. Your doctor may suggest using a topical corticosteroid cream on the psoriasis patches. Usually, a low-strength version is recommended because the skin in the genital area is thin and sensitive, and the less potent treatment is less likely to irritate it or cause the skin to get thinner. Your doctor may want to keep a close eye on you while using a corticosteroid, since long-time use can lead to resistance. Another treatment used to treat genital psoriasis is calcineurin inhibitors, which don’t lead to thinning of the genital skin but can cause burning. It can also reactivate sexually transmitted infections like herpes, so it’s not appropriate for everyone. For some severe cases, you may try an oral or injectable medication, like a biologic—a drug derived from a living organism that targets the inflammation causing psoriasis symptoms.

Some of the treatments used to treat psoriasis in other parts of the body aren’t recommended for genital psoriasis treatment, however. For example, ultraviolet (UV) light treatment is only used in rare circumstances for genital psoriasis, because it can burn the sensitive skin and increase the chances of skin cancer. Coal tar-based products are another no-go for the genital area, since coal tar causes irritation. So even if you’re using a treatment for psoriasis in another area of your body, don’t assume it will be just fine to use in the genital region, too. Talk to your doctor before using any product.

Adapt the Right Coping Techniques

Once you have the right treatment on board, you can figure out some lifestyle adjustments to accommodate the discomfort that a flare-up of genital psoriasis can cause. Some of these changes are fairly simple, while others may require more of an ongoing commitment.

  • Buy soft toilet paper. The thin, scratchy kind may irritate your already-irritated skin. Opt for something thicker, softer, and gentler on your skin.

  • Use moisturizer. Make it your goal to find a gentle, unscented moisturizer and apply it regularly to your skin.

  • Stay clean. Use a fragrance-free soap when bathing. After having sex, be sure to gently clean the genital area and reapply topical medications when necessary.

  • Baby your skin. When you dry off with a towel after bathing, pat your skin very gently instead of rubbing.

  • Love a loose fit. Tight-fitting clothes and underwear will rub against your skin, and that friction can cause irritation and pain. Embrace looser-fitting attire and breathe a sigh of relief.

Talk to Your Partner

You know genital psoriasis is not contagious. You know it’s not a sexually transmitted disease. You know you didn’t do anything to develop it. But it can still cause you some anxiety. You may still feel embarrassed for someone to see the lesions or patches on your skin when you’re undressed. Take a deep breath and talk to your partner about your situation. Tell them about your feelings. Give them the same information about genital psoriasis that your doctor gave to you when you were diagnosed so they’ll have all the facts. It’s easier to take care of yourself when you have support from a loved one, and it may also improve intimacy with your partner.

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Last Review Date: 2018 Aug 16
  1. Cather JC, Ryan C, Meeuwis K, et al. Patients’ Perspectives
    on the Impact of Genital Psoriasis: A Qualitative Study. Dermatology and
    Therapy. 2017;7(4):447-461. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698203/
  2. Genital Psoriasis. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/specific-locations/genitals
  3. Genital psoriasis: how to treat and manage it. National
    Psoriasis Foundation. https://www.psoriasis.org/advance/genital-psoriasis-how-to-treat-it-how-to-manage-it
  4. How can I treat genital psoriasis? American Academy of
    Dermatology. https://www.aad.org/public/diseases/scaly-skin/psoriasis/diagnosis-and-treatment-of-psoriasis/how-ca...
  5. Inverse Psoriasis. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/types/inverse
  6. Psoriasis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
  7. Psoriasis and intimacy. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/living-well/psoriasis-and-intimacy
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