The most common type of psoriasis in the genital region is inverse psoriasis. This type of psoriasis first shows up as smooth, dry, red lesions. It usually lacks the scale associated with plaque psoriasis.
There are various regions of the genital area that can be affected by psoriasis:
- Pubis: The pubis is the region on males and females above the genitals. This area can be treated similarly to psoriasis on the scalp; however, use caution. Skin in the pubic region is more sensitive than the skin on the scalp.
- Upper thighs: Psoriasis on the upper thighs often consists of many small, round patches that are red and scaly. Psoriasis in between the thighs is easily irritated, especially if the thighs rub together when you walk or run.
- Creases between thigh and groin: Psoriasis generally appears as non-scaly and reddish-white in the creases between the thigh and groin. The skin may have fissures (cracks). People who are overweight or athletic may have an infection called intertrigo, which looks similar to a yeast infection in the folds of the skin.
- Genitals: Psoriasis of the vulva often appears as a smooth, non-scaly redness. Scratching this area may cause an infection, create dryness, and result in thickening of the skin and further itching. Genital psoriasis usually affects the outer skin of the vagina because psoriasis does not normally affect mucous membranes. In general, genital psoriasis does not affect the urethra.
Psoriasis of the penis may appear as many small, red patches on the glans, or shaft. The skin may be scaly or smooth and shiny. Genital psoriasis affects both circumcised and uncircumcised males.
- Anus and surrounding skin: Psoriasis on or near the anus is red, non-scaly and prone to itchiness. Psoriasis in this area may be confused with yeast, infections, hemorrhoidal itching and pinworm infestations. The presence of these conditions can complicate the treatment of psoriasis. Rectal examinations and skin cultures can confirm these conditions. Symptoms of anal psoriasis may include bleeding, pain during bowel movements, and excessive dryness and itching.
- Buttocks crease: Psoriasis in the buttocks crease may be red and non-scaly or red with very heavy scales. The skin in this area is not as fragile as that of the groin.
Genital psoriasis can be difficult and frustrating to treat. However, it generally responds well to treatment. Due to the sensitivity of genital skin, treatment requires some special consideration. It is important to remember that response times to treatments vary among individuals. If your treatment is not working, see your doctor to discuss other treatment options. Topicals and ultraviolet (UV) light are most often used. Doctors generally don't prescribe systemic medications for genital psoriasis alone. However, they may if psoriasis is severe or resistant to topical therapy, or also appears on other parts of the body.
Use only low-strength topical corticosteroid preparations in the genital area. Skin in the genital area tends to be more sensitive and thin. Use corticosteroids carefully and as directed by your doctor. Prolonged use of topical corticosteroids can permanently thin the skin and cause stretch marks.
Over-the-counter moisturizers can be used to keep the skin moisturized. Be cautious, as ingredients in some lotions or creams may be irritating to the genital area's sensitive skin. Look for moisturizers without fragrance and perfumes. If you read the labels of various moisturizers, you will find most of them contain a combination of the same general ingredients. However, they may differ in consistency. The most important thing is to find a moisturizer that softens the skin as much as needed.
Ultraviolet (UV) light can be used to treat some genital psoriasis, but only in special circumstances. The doses must be much lower than are normally used to treat psoriasis on other areas of the body. Overexposure to UV light can burn thin genital area skin.