Go More Than Skin Deep on Diagnosing and Treating Genital Psoriasis

If you experience psoriasis—a skin condition that can cause a scaly, itchy, patchy rash—on any part of your body, it's likely you may experience psoriasis in the genital area at some point. More than 3 percent of the United States adult population, 7.5 million people or more, will develop psoriasis. That's a lot of people who may run into uncomfortable rashes on their genitals.

"Over half of the people who have psoriasis will experience genital lesions as the condition develops and spreads, which means it can be fairly common to have problems in your sensitive areas if you have psoriasis anywhere else," said Daniel Atkinson, M.B.B.S., who is based in England and serves as the general practitioner clinical lead at online healthcare provider Treated.

What does genital psoriasis look like?

Genital psoriasis can look like red and tight or scaly lesions. Women may see lesions on the skin of the vulva, clitoris and perineum. In men, the skin of the penis, scrotum and perineum may be affected.

Psoriasis is the result of an autoimmune response that signals an increased production of skin cells. It cannot be cured but can be effectively managed in the long term.

Ensuring long-term management of genital psoriasis, however, begins with a diagnosis from a doctor, according to Marjorie Montanez-Wiscovich, M.D., Ph.D., a clinical assistant professor in the dermatology department at the University of Florida College of Medicine in Gainesville, Florida.

"Sometimes it can feel taboo to talk about those areas of our body, but we as dermatologists understand any skin can have a condition that we can help our patients with. We are used to seeing all skin," she said. "The bottom line: If you have any symptoms, get a doctor's examination."

How is genital psoriasis diagnosed?

If you notice a lesion on your genitals, especially if it itches or burns, check in with your primary care provider. They may be able to diagnose the condition and begin treatments for genital psoriasis. You'll likely need to visit a dermatologist for a full physical examination.

"Psoriasis is a clinical diagnosis, which means a board-certified dermatologist can diagnose you with a physical examination. We prefer to look at all your skin and your nails because psoriasis can cause changes to your nails," Montanez-Wiscovich said. "If other diagnoses are being considered, a biopsy may be suggested to rule out any other condition, but that's not needed to make the psoriasis diagnosis. No blood testing is needed either."

Many other common skin conditions can be confused for genital psoriasis, Montanez-Wiscovich and Atkinson said. Before you disappear down an internet-fueled, self-diagnosis rabbit hole, make an appointment with a medical professional.

What other conditions mimic genital psoriasis?

People mistake a number of other conditions for genital psoriasis. One of the most common is eczema, which creates dry, bright red patches of skin similar to psoriasis. Other rashes, too, get mistaken for psoriasis.

"Lichen sclerosus [sometimes called LS or white spot disease] can cause a raised, red, very itchy rash on the vulva, and it's associated with pain during intercourse, but it's less common than psoriasis," Montanez-Wiscovich said. "Lichen planus is even less common but can present in the genitalia and is also miserably itchy."

Montanez-Wiscovich said allergic contact dermatitis is the condition most frequently confused for genital psoriasis in her practice.

"Allergic contact dermatitis creates inflammation and soreness when your skin reacts to an irritant," Atkinson said. "Exposure to sweat or urine, or even just friction from skin touching adjacent skin, can make the area red, itchy, burning and raw."

Sexually transmitted infections (STIs) and sexually transmitted diseases (STDs) can cause psoriasis-like symptoms around the genitals. These include genital herpes and syphilis, according to Atkinson. Fungal infections, such as thrush, do the same thing.

From a yeast infection to tinea cruris, also known as jock itch, many skin infections can create irritation easily confused with psoriasis.

"In this area, a yeast infection with candida bacteria can look similar to psoriasis. Erythrasma, a rare and very easy-to-treat superficial infection caused by bacteria, can be confused with inverse psoriasis, which causes red, tight skin. Fungal infections like jock itch have slightly different patterns and colors from genital psoriasis," Montanez-Wiscovich said. "Some people have reactions to personal care products, condoms, underwear elastic or glue used in period products."

When should you seek medical care for genital psoriasis?

Though genital psoriasis isn't a condition you usually need to seek emergency care for, Montanez-Wiscovich said people with genital psoriasis should seek medical treatment if it causes symptoms that disrupt their sleep or affects their relationships with others or their emotional health.

Without treatment, symptoms likely will remain, Atkinson said.

"The symptoms may trickle into other areas of a patient's life," he added. "Just because you don't treat psoriasis doesn't mean it will get worse, however. For most patients, psoriasis will stay in high-trigger areas."

How is genital psoriasis treated?

Genital psoriasis cannot be cured. Medical professionals can, however, offer several treatments that target flare-ups. The goal is to reduce the severity and length of flares over time.

"Rarely do we get complete clearance. We try to have as many good days as possible," Montanez-Wiscovich said, adding that the treatment your doctor recommends will depend on the severity of the lesions and the amount of skin affected.

With genital psoriasis, creams are generally prescribed, like a prescription-strength topical cortisone cream or a corticosteroid of mid-grade potency.

"If this initial therapy isn't useful, there are other, steroid-free, anti-inflammatory creams we may use," Montanez-Wiscovich said. "If you and your doctor have given all the creams a try, there are several oral therapies or injectables that target specific inflammatory pathways that your doctor may suggest."

How to prevent psoriasis flare-ups

Montanez-Wiscovich and Atkinson pointed to many strategies you can employ to prevent flares of your genital psoriasis. These practices, they say, work best in tandem with the treatment plan assigned by your doctor.

• Avoid injury to the skin. "Wear loose-fitting clothing, shave carefully, and consider avoiding tattoos and piercings in the affected area," Montanez-Wiscovich said.
• Treat any skin infection quickly. "Always let your doctor know if the treatment you've been recommended causes further irritation," Atkinson said.
• Use products that are gentle on the skin. Atkinson recommends avoiding perfumed toilet paper or harsh soaps and detergents. Opt for sensitive formulations.
• Be mindful of hygiene in the affected area. "Keep this skin dry and avoid contact with urine, feces and sweat," Montanez-Wiscovich said.

It's not always easy to seek help, especially for something as personal and sensitive as a rash on your genitals. Making that first step can be difficult.

Video visits have become a viable option for most people, and more physicians and therapists have added them as a service. Giddy Telehealth makes it easy to get connected to a qualified healthcare professional who can help with a variety of conditions.