An Overview of Genital Psoriasis

Genital psoriasis is a form of psoriasis, a chronic skin condition, that occurs on or around the genitals. Red, itchy patches can form on the penis, scrotum, testicles, labia, vulva, clitoris, and other parts of the genitalia.

Genital psoriasis isn't a sexually transmitted infection. You can't get it from someone else or pass it along to others. Rather, it's caused by an immune response that attacks healthy skin cells.

Although genital psoriasis can develop on its own, it most often accompanies psoriasis on other parts of the body, such as the knees, elbows, or scalp.

This article discusses genital psoriasis, its symptoms, causes, and treatment. It also offers suggestions on how to cope when you have this form of psoriasis.

Symptoms of Genital Psoriasis

Psoriasis is characterized by inflammation and the rapid build-up of skin cells on the outermost layer of skin called the epidermis. Because the cells are being produced faster than they can be shed, the affected skin develops red, inflamed patches (plaques) covered with white to silvery scales.

Itching and dandruff-like flaking are common. When scratched, the plaques will easily bleed and worsen. Over time, the plaques can consolidate and create large areas of dry, cracked skin.

Your symptoms may vary depending on the type of psoriasis you have:

• Plaque psoriasis is the most common form, accounting for roughly 80% of cases. It tends to appear as described above.
• Pustular psoriasis causes the eruption of pus-filled blisters on the affected skin.
• Inverse psoriasis tends to be smooth and discolored. Cracks can form in folds of skin.

Where Plaques Can Form

Genital psoriasis can appear on the:

• Penis
• Labia
• Vulva
• Citoris
• Scrotum
• Testicles
• Anus

The lining inside the vagina or rectum is typically unaffected.

The skin on these parts of the body is very delicate and rich in nerve endings. Abrasions, cracks, and bleeding can easily lead to secondary infections.

To complicate matters, some of the topical drugs used to treat psoriasis on other parts of the body can cause pain or discomfort when applied to the genitals.

Sexual Problems

Genital psoriasis can interfere with your sex life due not only to the physical symptoms but the embarrassment of having to explain the condition to a sexual partner.

Weeping and inflamed skin can often be misread as a sexually transmitted infection such as herpes or genital warts. Rather than face rejection, some people simply avoid sex, leading to isolation and depression.

Even if your psoriasis is under control, the friction induced by intercourse can inadvertently trigger an outbreak of symptoms called a flare. Certain lubricants, particularly spermicidal ones, may irritate the skin and trigger a flare as well.

According to a 2015 study, no less than 43% of people with genital psoriasis report decreased sexual intercourse as a result of their physical and emotional symptoms.

Causes

Genital psoriasis—and all other forms of the condition—are caused by a problem with the immune system.

For reasons poorly understood, the immune system will suddenly attack normal cells and tissues. With psoriasis, the assault is primarily focused on keratinocytes, a type of skin cells that makes up 90% of the epidermis.

When this happens, the ensuing inflammation causes overproduction of keratinocytes, leading to the formation of plaques.

It has been proposed that past infections or skin traumas may increase the density of keratinocytes in genital tissues, providing more "targets" for the autoimmune assault. Further research is needed to support this hypothesis.

Genetics and Genital Psoriasis Triggers

Scientists believe that psoriasis affecting any part of the body is caused by a combination of genetic and environmental factors. Several genetic mutations have already been identified that appear to predispose an individual to the disease.

However, the actual expression of the disease may require an environmental trigger, such as an infection, for symptoms to manifest.

Like psoriasis on other parts of the body, genital psoriasis may flare up in response to triggers like illness or stress. It's often hard to know what triggers flare-ups, however, which can make them difficult to prevent.

How Common Is Genital Psoriasis?

Genital psoriasis is common. According to a 2018 study, 33% to 63% of people with psoriasis will develop genital psoriasis at some point in their life.

It can affect both men and women, though there is no clear explanation as to why some people develop genital psoriasis and others don't.

Diagnosis

Genital psoriasis is diagnosed based on a review of your symptoms and medical history. Certain conditions or a family history may place you at an increased risk for psoriasis or reveal alternate explanations for your condition (such as contact dermatitis).

If your symptoms are atypical or you are resistant to treatment, your dermatologist may obtain a tissue sample by scraping or biopsying the skin. Psoriatic tissue will have dense, compacted cells when viewed under a microscope. This can help differentiate psoriasis from other likely causes, such as eczema or cancer.

Unlike some autoimmune disorders, there are no blood tests or imaging studies that can definitively diagnose psoriasis.

Psoriasis Doctor Discussion Guide

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How Do You Get Rid of Genital Psoriasis?

Psoriasis cannot be cured, but it can be managed to reduce symptoms and flare-ups. The genital area is treated differently than other parts of the body that may be affected by this chronic condition.

Medication used to treat psoriasis on the scalp or elbows, for example, is too harsh and/or concentrated to be applied to the labia or scrotum. These creams would penetrate the thin, sensitive skin of the genitals more profusely, increasing the risk of side effects.

Over-the-Counter (OTC) Treatments

Low-potency topical medications are typically used in the first-line treatment of genital psoriasis. This is to reduce the risk of side effects and damage to already-affected skin.

These medications are used on a case-by-case basis under the direction of a dermatologist, who can adjust dosages and show you how and where to apply them safely.

Mild genital psoriasis is typically treated with a short course of an over-the-counter 1.0% hydrocortisone ointment. Higher-dose hydrocortisone can be irritating and may cause irreversible skin thinning (atrophy) if overused, increasing the risk of painful intercourse (dyspareunia).

Mild coal tar is another, though less common, OTC option. It can be used alone or alongside hydrocortisone cream on the external genitalia only.

Prescriptions

If long-term therapy is needed, Dovonex (calcipotriene cream) is considered a safe and effective option. It is available by prescription and can be used on the more delicate tissues of the vulva, clitoris, and anus.

Protopic (tacrolimus) and Elidel (pimecrolimus) are topical immunosuppressants that are reserved for people who fail to respond to hydrocortisone or Dovonex.

If the skin becomes infected, topical antibiotics may be prescribed.

Your healthcare provider may also recommend applying lubricants or emollients to relieve or prevent skin dryness and cracking when using these drugs.

Other prescriptions may be considered if these treatments prove ineffective.

Options for Severe, Stubborn Cases

If these options don't work, prescription topical steroids may be used under the supervision of a dermatologist.

If your symptoms are severe, systemic treatment may be required. Generally speaking, these oral and injectable drugs are reserved for when psoriasis involves more than 10% of the body surface area, rather than just the genitals alone. Options include:

• Methotrexate, a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and other autoimmune disorders
• Acitretin, an oral retinoid drug that can reduce inflammation
• Biologic drugs, such as Humira (adalimumab), Orencia (abatacept), Enbrel (etanercept), and Rituxan (rituximab), which interrupt immune signals that trigger autoimmune symptoms

Phototherapy, a technique involving UV light exposure and drugs that activate in response to it, is not commonly used to treat genital psoriasis but may be explored if larger areas of skin are involved.

Self-Care Tips

In addition to treatment, there are strategies that can help you cope and/or prevent the recurrence of genital psoriasis. Among some of the more useful self-help tips:

• Use mild, fragrance-free cleansers: When bathing, avoid antibacterial soaps and body washes. These can irritate delicate skin and cause psoriasis flares. (The same goes for deodorant products.)
• Use quality toilet paper: This can help reduce irritation. Pre-moistened disposable wipes (non-fragranced) can also be soothing.
• Take care when wiping: Avoid getting urine or feces on genital psoriasis patches, as this can cause flares. In addition, the introduction of feces onto dried, cracked skin can lead to secondary infections.
• Wear loose-fitting underwear and clothing: Tight-fitting clothing can cause friction, which can worsen genital psoriasis.

Sex With Genital Psoriasis

When it comes to sex when you have genital psoriasis:

• Communicate with your partner: Because people can mistake a psoriasis outbreak for a sexually transmitted infection, advise your partner about your condition before having sex.
• Use condoms: Using a condom may help reduce some of the friction that can induce a flare. Use plenty of hypoallergenic, water-based lubricant as well (this type is less likely to compromise latex condoms).
• Explore other forms of sex: Sexual intercourse is only one of the many varieties of sex you can enjoy. If your genitals are too sore for penetration, explore mutual masturbation with light touching. Some sex toys can provide pleasure without causing too much friction. Role-playing can also be enjoyable and compel you to interact on a more intimate level.

Summary

Genital psoriasis is a form of psoriasis that appears on the genitals, such as on the penis, scrotum, or vulva. It is similar to psoriasis that appears elsewhere, though you may not notice scales since these often flake off with movement.

Genital psoriasis flare-ups can be triggered by environmental factors such as stress or illness. It can be very uncomfortable and may cause sexual problems as well as emotional problems.

Treatment for genital psoriasis is different than treatment for other forms of the disease. This is because the skin around the genitals is thinner and more sensitive than it is on other parts of the body.