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Genital psoriasis: How to treat it, how to manage it

When Vanessa Beck started to experience vaginal dryness, she assumed that changing hormones from a hysterectomy were to blame.

But Beck, who has psoriasis and psoriatic arthritis, quickly learned that she had genital psoriasis. That was a year ago. Beck, who doesn't have insurance, has found some relief treating it with olive oil.

"It doesn't ever completely go away," Beck said.

The most common type of psoriasis in the genital area is inverse psoriasis. It usually appears as smooth, dry, red lesions. It can occur on the upper thighs, in the creases between the thigh and groin, near the anus, in the pubis area above the genitals and on the genitals themselves.

Treating genital psoriasis can be tricky, but successful, said Abby Jacobson, a physician assistant with Delaware Valley Dermatology in Lancaster, Pa., and a member of the National Psoriasis Foundation Medical Board.

Here are some things you should know:

Be honest. Patients need to be open and honest, and as embarrassing as it may seem, the health care provider needs to see the genital psoriasis to treat it effectively.

"Trust me, as health care providers, we've gone to school for decades, we do ob/gyn rotations," Jacobson said. "It's not gross … you don't go into health care if you don't feel comfortable looking everywhere."

Honesty also is important when it comes to treatment. For example, if a patient is going to feel uncomfortable using a slippery topical to treat psoriasis in the anal area, they are unlikely to use it.

"We need to know why you didn't use it, because we are going to give it to the next psoriasis patient," Jacobson said.

Your treatment options. Because genital skin is thin, many topicals used for other parts of the body are not an option. Your health care provider may prescribe a low-dose steroid, but limit its use. Frequent use of steroid creams can thin the skin and cause stretch marks. Vitamin D compounds also can be a good choice.

"The bottom line is finding a provider who is willing to hear or see things, hear you out and conversely, accept that there will be a degree of trial-and-error figuring out what you can comfortably and safely use," Jacobson said.

However, just having psoriasis in the genital area increases its severity, even if you are clear elsewhere. Because of that, consider discussing systemic or biologic treatments, especially if your genital psoriasis is not responding to topicals, Jacobson said.

Protection is key. The genital area can be exposed to repeated friction from clothing, underwear, proper cleaning after bowel movements and also from sex. Injury in this area from friction can lead to a Koebner phenomenon, or a flare-up of psoriasis plaques, Jacobson said. Using quality toilet paper, loose-fitting underwear (boxers over briefs, "boy shorts" over a thong, as examples) and even using a fiber supplement to ease defecation can help prevent a flare-up.

Using lubricants or a lubricated condom can help prevent a friction injury from sex. It's also important to keep in mind that if you are using a treatment in the genital area to inform your sexual partner so he or she can keep a look out for a skin reaction on their end.


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