Genital Psoriasis

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What is Genital Psoriasis?

As the term suggests, genital psoriasis is psoriasis in the genital area. Sometimes this can be the only area affected by psoriasis, and the problem can range from just a few small spots to large plaques.

Usually, genital psoriasis does not have the typical appearance of thick red scaly plaques that are seen in other areas. It appears as bright red, shiny patches of skin with no scale on top. The reason for this is that friction between the two skin surfaces in the groin rubs off the scales.

Genital psoriasis can also affect children especially babies, and this is known as napkin psoriasis.

What causes genital psoriasis?

Psoriasis commonly affects genital areas, but it is not always easy to identify what the triggers are. In the flexures and groin area it may be worsened by tight clothing rubbing the skin, by deodorants or antiperspirants, or by contraceptives – sheaths, caps and spermicides, sanitary towels or tampons, harsh toilet paper, thrush or sexual intercourse.

Why does genital psoriasis sometimes require specific treatments?

The absence of scaliness is most obvious in the skin flexures or folds because the continual friction between the two skin surfaces rubs them off. The enclosed area of a skin fold and thinness of the skin in sensitive areas can affect the action of topically applied treatments (ie creams and ointments). In both there is a tendency for an increase in the absorption of the treatment through the skin thereby enhancing its effect. In addition, the potential for a cream or ointment to cause irritation is increased when it is applied in a flexure and comes into contact with two skin surfaces that are rubbing together. For these reasons specific creams and ointments are advisable for use in sensitive areas of the skin, some creams or ointments are not recommended at all.

Coping with Genital Psoriasis

Skin diseases can be difficult to cope with and a skin disease that affects the genitals can be doubly so. It can be embarrassing to discuss genital psoriasis with a doctor or nurse.

Try to remember there is nothing to be embarrassed about. Overcoming your natural reluctance to discuss these matters, and learning how to be up-front with your doctor and loved ones can make coping with psoriasis much easier.

Honesty and openness are key factors in coming to terms with your situation. If your partner knows how genital psoriasis is affecting you, he or she will be better able to support you emotionally and physically. Equally, your doctor will be in a better position to help you.

Remember, they want to help you, so let them know how you are feeling.

Genital psoriasis can cause irritation and discomfort during sexual intercourse which can affect sexual relations with your partner. Effective medication will help to relieve this problem. In addition, it may be helpful for the man to wear a condom as this might limit any irritation or discomfort. It is also important to wash all medications from the genital area prior to intercourse to avoid transfer of the medications to your partner.

In men they may find it difficult to have an erection because their penile skin may contain cracks or bleed. This can lead to tensions within a sexual relationship therefore talking to your partner or being in an understanding relationship can help defuse any emotional complications.

Using a condom during intercourse may reduce any discomfort, as the condom will act as a barrier to avoid skin-to-skin and fluid to skin contact, which cuts down on irritation. Good personal hygiene prior to intercourse is equally important to avoid any transference of medications to your partner. After intercourse, cleansing the area and reapplying the medications or emollients as directed by your doctor will also aid recovery.

During a flare should I refrain from sexual intercourse?

Not necessarily – a flare may be exacerbated by sex, due to friction causing a Koebner reaction and it may be painful.

What should I do if I have genital psoriasis?

Genital psoriasis may also affect the surrounding area in the groin. It rarely appears in the vagina. If you develop psoriasis of the genitalia you should always consult your doctor. Do not be embarrassed.

Genital psoriasis can sometimes look similar to a fungal or bacterial infection, even contact dermatitis, your doctor may need to check the diagnosis with a laboratory test before starting any treatment. The delicate skin in the genital area may mean you need a weaker psoriasis treatment than elsewhere on your body. You should bear in mind that you may be susceptible to irritant and allergic reactions from your under garments by harsh laundry detergents and current medications.

It is important to remember that psoriasis is not due to an infection and is not catching. Consequently, when you are in a loving relationship with a partner who knows about your psoriasis, it should not interfere with your sex life. If you are with a new partner, explain your condition before you become intimate.

If your partner is worried, you can show him or her leaflets on psoriasis, ask your doctor to explain the problem, or even attend a genito-urinary clinic together for a joint check-up. Treatment at Genito-Urinary Medicine (GUM) clinics is free and confidential. You can find their telephone number and clinic times by phoning your local hospital.

Affected sites

The pubic region – a common site of genital psoriasis which can be treated in the same way as scalp psoriasis but be aware that the skin in this area is likely to be more sensitive than on the scalp.
Upper thighs – the appearance of psoriasis on the upper thighs are likely to be small round patches which are red and scaly. Any psoriasis between the thighs can become more easily irritated by the friction caused of thighs rubbing together when mobile. Reducing the friction between your legs will relieve sweatiness and irritation.
Skin folds between thigh and groin – psoriasis in this area will normally appear non scaly and reddish white in the creases between the thigh and groin and may become sore with cracks forming. Overweight, or sporting people may be susceptible to thrush in the skin folds which can be mistaken for psoriasis. Like genital psoriasis it can cause the same irritation from friction of the skin thus a correct diagnosis is essential for proper treatment.
Psoriasis of the vulva commonly appears to be smooth, non scaly and red. In this sensitive region irritation can be caused by scratching and may become infected and worsen the psoriasis. Scratching can also produce dryness thickening and further itching of the psoriasis. Always make sure you wash your hands and finger nails. Personal hygiene is essential and paramount.
Genital psoriasis in women will normally affect the outer skin of the genitals. The vagina and mucus membranes surrounding it will not normally be affected. The urethra (the canal expelling urine) is not normally affected.
In men the appearance of psoriasis on the penis may consist of small red patches on the glans (tip of the penis) or shaft, and the skin may also appear to be shiny. Psoriasis of the penis can affect either those who have been circumcised or not.
The anus – Psoriasis on the anus and surrounding areas will normally appear to be red, non scaly and can become itchy and weepy and sore. Again psoriasis in this area may be confused with other infections such as yeast fungal infections, worms, haemorrhoid itching and streptococcal infections. It is essential that you consult your doctor for a prompt and correct diagnosis. In some cases symptoms can include bleeding, pain during bowel movements, dryness and itching, together with soreness.
Buttocks – psoriasis in the buttock folds may appear as red non scaly or red with very heavy scaling. The skin in this area is not as fragile as that of the groin.

What treatments may or may not be used in Genital Psoriasis?

Prescribed treatments for genital psoriasis usually have good outcomes but you must always be careful to comply correctly with your doctor’s directions as these skin areas are delicate.

When treating genital psoriasis it is important to keep the affected areas moisturised. When using moisturisers if any irritation occurs this may be due to sensitivity to some of the ingredients in them.

If you develop genital psoriasis, you should discuss it with your doctor who will be able to advise you on suitable treatments. Here is a summary of topical treatments which may or may not be used in genital psoriasis.

Emollients are an important part of the daily care of psoriasis in all parts of the body, including the genitalia. They help to make the skin more comfortable. In addition, there is a range of topical treatments available - creams and ointments - that your doctor can prescribe.

Topical vitamin D creams and ointments are effective in treating psoriasis and the newer types are less likely to cause irritation. However, some of them do have the potential to irritate sensitive areas such as the genitalia. Some doctors recommend cautious use of vitamin D analogue creams and ointments on genital skin.

Topical steroid creams may be recommended for sensitive areas. However, care should be taken with their use as the potential for increased absorption may lead to side effects such as skin thinning. For this reason low strength topical steroids are favoured for use in the genital area. It is also important that topical steroids are not used for long periods of time or without close supervision from your doctor. Prolonged use of high potency steroids can also cause stretch marks and you may become resistant to these medications in clearing the symptoms successfully.

Treatment should never be stopped abruptly as this may trigger a rebound flare of your psoriasis.

Topical steroids may also be combined with anti-fungal and anti-bacterial agents because infections with yeasts and bacteria in warm moist skin creases such as the groin are more common.

Dithranol and Vitamin A derivatives (retinoids) are not usually recommended for use in skin flexures because of their tendency to cause irritation.

Coal tar preparations are not usually recommended in genital areas because they can cause irritation, especially to the areas of the penis, the scrotum, the vulva or other cracked skin

Calcineurin inhibitors (tacrolimus and pimecrolimus) are effective in treating genital psoriasis and don’t have the side effect of thinning the skin that limit the use of topical steroids. They do however often cause an uncomfortable burning sensation when applied and can reactivate sexual transmitted infections such as herpes and viral warts.

UV light treatment is not usually recommended for genital psoriasis due to an increased risk of skin cancer in this area. Men with psoriasis undergoing UV light treatment are specifically advised to cover the genital area during treatment to reduce the risk of cancer in this area.