Genital psoriasis

As an autoimmune disorder, psoriasis is characterized by an immune system gone awry. For reasons poorly understood, the immune system will suddenly attack normal cells and tissues. With psoriasis, the assault will be primarily focused on keratinocytes, a type of skin cells that makes up 90% of the epidermis.

When this happens, the ensuing inflammation causes hyperproliferation (overproduction) of keratinocytes, leading to the formation of plaques.

It is unclear why some people experience psoriasis of the genitals in particular. It has been proposed that past infections or skin traumas may increase the density of keratinocytes in tissues, providing more “targets” for the autoimmune assault. Further research is needed to support this hypothesis.

NB – Genital psoriasis cannot be transmitted through sexual contact and has no impact on pregnancy, sexual function, or menopause.

Psoriasis of the genitals can often cause severe symptoms as the skin of the penis, labia, vulva, clitoris, scrotum, and anus is very delicate and rich in nerve endings. Abrasions, cracks, and bleeding can easily lead to secondary infections. To complicate matters, some of the topical drugs used to treat psoriasis on other parts of the body can cause pain or discomfort when applied to the genitals. 

Symptoms can vary in severity, but Psoriasis in the genital area in women can affect vulva, groin and thighs. Sometimes small fissures can be found in the skin.

In men, psoriasis can look like red spots on the penis, inside of the foreskin and scrotum. The foreskin can also become swollen. Rash is not painful and can scale.

Both women and men can also experience scaling and itching around the anus and on the buttocks. 

Genital psoriasis can interfere with your sex life due not only to the physical symptoms but the embarrassment of having to explain the condition to a sexual partner. Weeping and inflamed skin can often be misread as a sexually transmitted infection such as herpes or genital warts. Rather than face rejection, some people will simply avoid sex, leading to isolation and depression.

Even if your psoriasis is under control, the friction induced by intercourse can inadvertently trigger an outbreak of symptoms, called a flare. Certain lubricants, particularly spermicidal ones, may be irritating to the skin and trigger a flare.

Genital psoriasis is approached differently than psoriasis on other parts of the body. This is because topical drugs used to treat psoriasis elsewhere can penetrate the thin, sensitive skin of the genitals more profusely, increasing the risk of side effects. Medication used to treat psoriasis on the scalp or elbows, for example, would be too harsh and/or concentrated to be applied to the labia or scrotum. 

Low-potency topical medications are typically used in the first-line treatment of genital psoriasis to reduce the risk of side effects and damage to already-affected skin. These are used on a case-by-case basis under the direction of a dermatologist, who can adjust dosages and show you how (and where) to apply the medications safely.

Mild genital psoriasis is typically treated with a short course of an over-the-counter (OTC) 1.0% hydrocortisone ointment. 

If this doesn’t work or if longer term treatment is needed, prescription topical steroids may be prescribed by a doctor. 

In addition to treatment, there are strategies that can help you cope and/or prevent the recurrence of genital psoriasis. Among some of the more useful self-help tips:

• Use mild, fragrance-free cleansers: When bathing, avoid antibacterial soaps and body washes. These can irritate delicate skin and cause psoriasis flares. (The same goes for deodorant products.)
• Use quality toilet paper: This can help reduce irritation. Pre-moistened disposable wipes (non-fragranced) can also be soothing.
• Take care when wiping: Avoid getting urine or feces on genital psoriasis patches, as this can cause flares. In addition, the introduction of feces onto dried, cracked skin can lead to secondary infections.
• Wear loose-fitting underwear and clothing: Tight-fitting clothing can cause friction, which can worsen genital psoriasis.

Genital psoriasis, like psoriasis on other parts of the body, is something you will need to manage over the long term. If you begin to notice lesions in your genital area, it is important to speak with your doctor or dermatologist as soon as possible. By acting early, you may be able to control the condition and reduce the severity or frequency of flares.

APPOTEK can help you with genital psoriasis. A doctor will make a diagnosis based on your symptoms in the online consultation, then may prescribe treatment or refer you for further examination.