What Is Genital Psoriasis?

Signs and Symptoms of Genital Psoriasis

• Penis, scrotum, or vulva
• Pubis (the skin above the genitals)
• Crease between the buttocks, including the skin around the anus
• Inner and upper thigh
• Crease between the thigh and genital area

Of the various types of psoriasis, inverse psoriasis and plaque psoriasis commonly appear on the genitals.

Inverse psoriasis, which develops in the skin’s natural folds, or in places where skin rubs against skin, doesn’t have the telltale dry scales of plaque psoriasis, because it occurs in areas where there is excess moisture. Unlike plaque psoriasis, “inverse psoriasis often looks like a rash with sharp borders,” says Jeffrey I. Ellis, MD, a dermatologist at Northwell Health in Hicksville, New York.

Causes of Genital Psoriasis

• Stress
• Certain medications
• Injuries or trauma to the skin
• Infections
• Changes in weather
• Diet

How Is Genital Psoriasis Diagnosed

Genital psoriasis may be misdiagnosed or underdiagnosed. “Many people go undiagnosed for a long time because they’re too embarrassed to tell their doctors about their symptoms [such as soreness, itching, and burning],” says Dr. Ellis.

Inverse psoriasis, in particular, can be tough to diagnose — doctors often find it necessary to do a biopsy, according to Ellis. “When it appears in the groin area, it is often mistaken for a fungus, like jock itch. When it appears on the genitals, it may be mistaken for a sexually transmitted disease,” says Ellis.

Treatment and Medication Options for Genital Psoriasis

Medication Options for Genital Psoriasis

Topical medications include:

• A mild corticosteroid cream
• Prescription topicals like tapinarof (Vtama) and roflumilast (Zoryve)
• Calcipotriene cream (vitamin D cream)
• Pimecrolimus (Elidel) cream or tacrolimus (Prograf) ointment

Systemic medications include:

• Stronger oral medicines, such as cyclosporine (Neoral), methotrexate (Trexall), apremilast (Otezla), deucravacitinib (Sotyktu), icotrokinra (Icotyde), or retinoids
• An infused or injectable biologic

“All the treatments we use for other types of psoriasis may be used for genital psoriasis,” Ellis says.

Lifestyle Changes and Prevention of Genital Psoriasis

There’s no known way to prevent psoriasis, but in addition to medication, there are steps you can take to reduce your risk of flares.

The location of genital psoriasis can intensify symptoms. “One of the characteristics of psoriasis is the tendency for it to get worse with any kind of skin trauma,” Ellis says. In the groin area, that trauma can be caused by too-tight clothing, skin rubbing on skin, athletic activity, and sex. “All of these may make symptoms worse,” Ellis says.

Wearing loose clothing can help. Keeping skin hydrated is also an important part of managing genital psoriasis, says Ellis.

• Use a mild, fragrance-free cleanser. Avoid potentially irritating deodorant or antibacterial soaps and body washes.
• Apply fragrance-free moisturizer to the psoriasis after bathing, when skin is still damp. Also apply when the area feels dry to reduce rubbing and irritation. A good rule of thumb for products: the fewer ingredients on the label, the better.
• Use soft, high-quality toilet paper, to help avoid irritation.
• Avoid contact between genital psoriasis and urine or feces.
• To help ease bowel movements, consume a high-fiber diet or a fiber supplement.
• Avoid long, hot baths.
• Apply cool compresses to dry and itchy areas.

Genital Psoriasis Prognosis

The bottom line: “Let your dermatologist know about any symptoms,” Ellis says. “We have amazing treatments.”

Sex and Intimacy With Genital Psoriasis

If genital psoriasis is causing issues with intimacy, “sometimes it helps for a patient and their partner to come to a doctor visit together,” Ellis says.

One important thing to share with a partner: Genital psoriasis is not contagious.

• Avoid sex when the genital area is inflamed or raw.
• Use topical medication in genital areas only as directed by your doctor. Don’t try to speed healing by using more.
• Keep your genital area clean; wash gently after any sexual activity.
• Use a lubricated condom to avoid irritating inflamed areas.

Additional reporting by Paula Derrow.