The Facts About Genital Psoriasis

Living with a chronic illness often comes with an array of related physical, mental and emotional challenges. One such illness is psoriasis.

When you have psoriasis, symptoms are uncomfortable physically and often visible to others, which can affect self-esteem.

Psoriasis can be difficult enough when located on your legs or elbows, but what happens when psoriasis flares up in the genital area?

Let's take a look at what genital psoriasis is and how a quick diagnosis and appropriate treatment can help.

Since genital psoriasis is a type of psoriasis, it’s helpful to define what exactly psoriasis is.

The National Psoriasis Foundation defines the disorder as an immune-mediated disease, meaning its root cause is unclear and it results from inflammation in the body.

Individuals with psoriasis have overactive immune systems that cause the rapid growth of skin cells, which damages healthy skin cells. One of the hallmark symptoms of psoriasis is visible inflammation that can appear as raised plaques, scales and redness.

Psoriasis affects between 2 percent and 3 percent of the world’s population, including about 7.5 million adults in the United States, according to a report published in October 2021. Though psoriasis most commonly affects the hand, feet, neck and scalp, it can also affect the arms, legs, face and even the genitals. Research published in August 2018 indicated about 63 percent of psoriatic patients experience genital psoriasis at some point.

Genital psoriasis is caused by the same thing as psoriasis on other parts of the body. It's an autoimmune condition triggered by an overactive immune system. The immune system of someone with genital psoriasis causes the skin cells to replicate too rapidly, leading to inflammation and the uncomfortable, itchy and sometimes painful buildup of dead skin cells on the skin’s surface.

Experts do not know the exact reason the immune system of those with psoriasis acts the way it does, though it is believed genetics could play a role in the condition.

Healthy skin cells regenerate and eventually shed within a month. Skin cells affected by psoriasis, on the other hand, completely grow in three or four days. Rather than shedding, however, they continue to multiply and build up on the skin’s surface resulting in plaques, according to the National Psoriasis Foundation (NPF).

The disease is considered to be genital psoriasis when it affects the genital area. Genital psoriasis can flare up in or on the vulva, vagina, penis, scrotum, groin, upper pubic area above the genitals, the inner and upper thighs, and between the buttocks, including the skin surrounding the anus.

While genital psoriasis symptoms can manifest at any age, they typically appear between the ages of 15 and 25, according to the NPF.

Symptoms vary from person to person depending on the affected area and the severity of the flare-up. Genital psoriasis symptoms can include:

• Burning
• Dryness
• Fertility issues
• Flaky skin
• Intensification of symptoms when flare-up comes in contact with urine, feces, friction or sweat
• Itching
• Pain or discomfort during sexual activity
• Painful plaques, scales or redness
• Splitting of the skin

Psoriasis can also vary in size and appearance. On fair-skinned people, plaque psoriasis can look red and be topped by silvery-white scales. On darker skin, the plaques may look darker, ranging from deep red to purple, dark brown or even gray.

Genital psoriasis can be extremely uncomfortable and even painful. If you scratch the affected area it can lead to further irritation, bleeding and even infection.

Fortunately, genital psoriasis is a manageable condition and effective treatment is available. If you are experiencing symptoms of genital psoriasis, reach out to your doctor right away.

Inverse psoriasis usually appears as smooth red patches of skin that feel or look tight. This type of psoriasis is common in skin folds including the genital area, under the breasts or in the armpits.

It is common to have inverse psoriasis during a genital psoriasis flare-up, though it’s also possible to experience plaque psoriasis in the genital area.

Plaque psoriasis appears as a thick build-up of dead skin cells on the skin’s surface, ranging from a tiny spot to a larger area. Plaques can range in color from dark red, purple, brown or gray to red with whitish scales, depending on the color of the skin on which the plaque is present.

Genital psoriasis must be diagnosed by a doctor, whether your regular family doctor, a dermatologist or a rheumatologist.

A diagnosis is typically reached following a physical exam during which your doctor is able to visually examine your symptoms. In some instances, a skin biopsy may be ordered to rule out other conditions.

Even if you’ve had and successfully treated psoriasis on other parts of your body before, be sure to consult your doctor before applying anything—medications or otherwise—to your genital psoriasis. Your doctor will recommend a treatment appropriate for your specific case, giving special consideration to the thinness and sensitivity of the skin in the genital area.

Some medications commonly used to treat genital psoriasis, according to Cleveland Clinic, include:

• Calcipotriene cream
• Coal tar cream
• Corticosteroid cream
• Cyclosporine, methotrexate or a biologic for more severe flare-ups
• Pimecrolimus cream
• Roflumilast cream
• Tacrolimus ointment
• Tapinarof cream

As is the case with any medication, topical medications used to treat genital psoriasis carry their own potential for side effects. Talk to your doctor about possible side effects before applying any medication so you know what to expect.

It’s important to remember that genital psoriasis is an autoimmune condition and not a sexually transmitted infection (STI). Genital psoriasis is not contagious. This means you can still lead a fulfilling sex life with genital psoriasis.

In moments you’re experiencing a flare-up, it is best to avoid sex until your skin is in a healthier state, according to the American Academy of Dermatology (AAD).

For the most comfortable experience and to ensure you don’t further irritate your genital psoriasis, take time to clean the affected area with a mild, fragrance-free soap. Do the same thing after sex. These steps are essential to avoid further inflammation and to ensure you don’t transfer any topical medication to your partner during sex.

The AAD also recommends the use of lubricated condoms to reduce the risk of further irritating genital psoriasis.

Once you’re taken care of physically, be sure to take some time to talk to your partner about your condition. Keeping an open dialogue about how you feel can bring some emotional intimacy to the bedroom while ensuring you're both on the same page about your genital psoriasis.

Although genital psoriasis can begin at any age, there are two primary periods of onset. The first period is between 20 to 30 years old, and the second is from 50 to 60 years old.

There’s no surefire way to prevent psoriasis, or genital psoriasis for that matter. But just because you have the condition once doesn’t mean you will live your entire life with active symptoms. In fact, psoriasis typically goes through cycles of flare-ups during which symptoms are present and then periods of remission when symptoms are minimal or nonexistent.

Once psoriasis has been "cured," it can go away for weeks, months or years. But it may reappear at any time.

If you have genital psoriasis, here are some common triggers you should avoid to reduce your risk of flare-ups:

• Ditch the single-ply. Invest in quality toilet paper. Using soft toilet paper can help prevent skin irritation, which is often a trigger for flare-ups.
• Opt for looser clothes. Tight-fitting pants and underwear can lead to excess friction, which may trigger a flare-up.
• Pick your soap wisely. Soaps and body wash with added fragrances may serve as triggers for psoriatic flare-ups, so it’s best to avoid them.
• Take extra-special care of your skin. Moisturize regularly.

What triggers genital psoriasis?

Genital psoriasis flare-ups occur when the immune system becomes overactive and replicates skin cells too rapidly, resulting in a buildup of dead skin cells. This can lead to thick plaque buildup on the skin’s surface or red, tight spots called inverse psoriasis. Flare-ups are not preventable, though certain circumstances or triggers may make a flare-up more likely. Some triggers include excessive friction, using soaps with added fragrance, irritation to the skin, stress and more.

What does genital psoriasis look like?

Psoriasis can vary in size and appearance. On those with fair skin, plaque psoriasis can look red topped with silvery-white scales. On darker skin, the plaques may look darker, ranging from deep red to purple, dark brown or even gray. In the case of inverse psoriasis, symptoms may manifest as smooth red spots that are tight.

How do you treat psoriasis in the genital area?

Genital psoriasis is typically treated with topical medication. The type of medication your doctor prescribes may vary depending on the severity and location of your flare-up. If you think you may have genital psoriasis, you should make an appointment with your healthcare provider and get a checkup.