Last reviewed on by the National Psoriasis Foundation
One- to two-thirds of people with psoriasis experience genital psoriasis at some point in their lives. Treating psoriasis in an area with such sensitive skin requires specialized care. The most common type of psoriasis that people experience in the genital area is inverse psoriasis, followed by plaque psoriasis.
Inverse psoriasis usually occurs in body folds such as the underarms, under breasts and in the genital area.Symptoms can include red skin that is smooth (not scaly) and may look tight. Some people experience discomfort, pain, severe itching and spitting of the skin. Inverse psoriasis may be worsened by sweat and rubbing in the body fold areas.
Plaque psoriasis often occurs on the scalp, knees elbows and torso, but can also appear on the genitals. Symptoms can include raised red patches of skin with a silvery or white build-up of scaly dead skin cells. Some people experience discomfort, pain, itching and cracking.
There are various regions of the genital area that can be affected by psoriasis:
Genitals (including the vulva, penis and scrotum) can develop inverse or plaque psoriasis. Although uncommon, psoriasis can also develop inside the vagina. Around the vulva, inverse psoriasis is more common, but scratching and dryness may also cause plaques. Psoriasis of the penis can affect those that are circumcised and uncircumcised. Symptoms of inverse or plaque psoriasis may appear as small, red patches on the glans (tip of the penis) or shaft.
Pubis (the region above the genitals) can develop plaque psoriasis.
Upper thighs next to the genital area can develop small, round plaques. Psoriasis in between the thighs may also be more easily irritated from rubbing when you walk, run or move. Wearing spandex shorts beneath clothes or using baby powder can help to decrease the friction and reduce irritation.
Creases between the thigh and the genital area can develop inverse psoriasis that is non-scaly and reddish white. The skin may also experience cracks. This area may also develop fungal infections. Skin between the anus-to-vulva, anus-to-scrotum and skin around the anus can develop inverse psoriasis that is red, non-scaly and prone to itchiness. Other symptoms may include bleeding, pain during bowel movements and excessive dryness. Psoriasis in this area may be confused with fungal infections, hemorrhoidal itching, strep infections and even pinworm infestations. You may have a rectal exam or skin culture to rule these out and treat appropriately.
Crease between the buttocks can develop inverse or plaque psoriasis.
Genital psoriasis can be difficult to treat, so managing it often requires persistence. 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; however, there are a wide range of treatment options available. It’s important to work with a dermatologist to come up with a treatment plan.
Topicals (medicines applied directly on the skin) can work to moisturize, relieve pain and itch, reduce inflammation or slow down the high rate of skin cell growth. Topical treatments commonly used to treat genital psoriasis include: low-strength corticosteroids, calcipotriene (vitamin D derivative) and tazarotene (vitamin A derivative). Some treatments for eczema have also been found to be effective in treating psoriasis such as: tacrolimus and pimecrolimus.
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 or reduce itch. Be cautious, as ingredients in some lotions or creams may be irritating to the genital area's sensitive skin. Look for products without fragrance and perfumes.
Ultraviolet B (UVB) light can be used to treat some locations of genital psoriasis. The doses tend to be lower than those used to treat psoriasis on other areas of the body due to concern about sunburn.
Biologics or oral treatments
Systemic treatments such as biologics and oral treatments are generally not prescribed for genital psoriasis alone. They can be effective in treating genital psoriasis and may be considered for people who also have psoriasis on other places or for those who don’t respond well to other treatment options.