It doesn’t have to be that way. For one thing, genital psoriasis is nothing to be mortified about: It is, in fact, a common problem for people with psoriasis. According to a review of studies in December 2018 in Therapy and Dermatology, 63 percent of people with psoriasis develop the condition on their genitals at least once in their lifetime. Though people with genital psoriasis are likely to report having a worse quality of life, including depression, shame, and sexual distress, nearly half never mention psoriasis symptoms “down there” to a doctor, according to numerous studies. Even more surprising: “Doctors may be too embarrassed to look,” adds Dr. Ellis. “This is especially true when genital psoriasis is the only type of psoriasis [a patient has],” which is the case for 2 to 5 percent of people with psoriasis. This lack of awareness on the part of both doctors and patients, according to the 2018 review, often results in undertreatment. Patients may take matters into their own hands, turning to dubious remedies and making the condition worse. RELATED: Psoriasis: How to Deal With Cracked, Bleeding Skin
Penis, scrotum, or vulvaPubis (the skin above the genitals)Crease between the buttocks, including the skin around the anusInner and upper thighCrease between the thigh and genital area
While plaque psoriasis can appear on the genitals, more often the type of psoriasis that develops on this part of the body is called inverse psoriasis — a type that develops in the skin’s natural folds, or in places where skin rubs against skin, according to the NPF. Inverse psoriasis doesn’t have the telltale dry scales of plaque psoriasis, because it occurs in areas where there is excess moisture. Unlike plaque psoriasis, “Inverse psoriasis often looks like a rash with sharp borders,” says Ellis. “But when it appears in the groin area, it is often mistaken for a fungus, like jock itch. When it appears on the genitals, it may be mistaken for a sexually transmitted disease,” says Ellis. Inverse psoriasis may be underreported, in part because it can be tough to diagnose — doctors often find it necessary to do a skin biopsy, according to Ellis. RELATED: How to Manage Psoriasis Flares in Sensitive Areas
Treatment for Genital Psoriasis
When it comes to treating genital psoriasis, there’s good and bad news. Though the rash occurs on skin that tends to be thinner and more sensitive than other areas of the body, “It also tends to be more responsive to treatment,” assures Ellis. “You have to proceed gently, but you can often get symptoms to clear up completely.” According to the American Academy of Dermatology, some of the most common therapies include:
Medication applied to the skin, such as vitamin D, or a mild corticosteroid creamMedium-strength or potent corticosteroids (used for a short time)Mild tar preparationsCalcipotriene creamPimecrolimus cream or tacrolimus ointmentStronger oral medicine such as cyclosporine, Trexall (methotrexate), or retinoidsAn infused or injectable biologicUltraviolet light treatments
“All the treatments we use for other types of psoriasis may be used for genital psoriasis,” Ellis says. “Dapsone, an antifungal medication, may also be used as an alternative to other treatments,” he adds.
Tips for Managing Genital Psoriasis Symptoms
The location of genital psoriasis can intensify symptoms. “One of the characteristics of psoriasis is the tendency for it to get worse with any kind of skin trauma,” Ellis says. In the groin area, that trauma can be caused by too-tight clothing, skin rubbing on skin, athletic activity, and sex. ”All of these may make symptoms worse,” Ellis says. Wearing loose clothing can help. Keeping skin hydrated is also an important part of management, says Ellis. Here are some tips for caring for skin when you have genital psoriasis, according to the American Academy of Dermatology:
Use a mild, fragrance-free cleanser. Avoid potentially irritating deodorant or antibacterial soaps and body washes.Apply fragrance-free moisturizer to the psoriasis after bathing, when skin is still damp. Also apply when the area feels dry to reduce rubbing and irritation. A good rule of thumb for products: the fewer ingredients on the label, the better.Use quality toilet paper.Avoid contact between genital psoriasis and urine or feces.Get plenty of fiber in your diet. A high-fiber diet or a fiber supplement will ease bowel movements.Avoid long, hot baths.Apply cool compresses to dry and itchy areas.
The bottom line: “Let your dermatologist know about any symptoms,” Ellis emphasizes. “We have amazing treatments.”
Now Let’s Talk About Sex With Genital Psoriasis
Not surprisingly, genital psoriasis can complicate your sex life. Indeed, more than 40 percent of people with psoriasis (and not just genital psoriasis) report some kind of sexual dysfunction, likely due to the emotional stressors that go along with the condition, according to a report published in December 2018 in the New Zealand journal Psoriasis. If genital psoriasis is causing issues with intimacy, “sometimes it helps for a patient and their partner to come to a doctor visit together," Ellis says. One important thing to share with a partner: Genital psoriasis is not contagious. More tips to make sex easier:
Avoid sex when the genital area is inflamed or raw.Use topical medication in genital areas only as directed by your doctor. Don’t try to speed healing by using more.Keep your genital area clean; wash gently after any sexual activity.Use a lubricated condom to avoid irritating inflamed areas.
RELATED: How to Have a Better Dating Life if You Have Psoriasis Additional reporting by Paula Derrow.
