What is genital psoriasis?

Psoriasis is a chronic autoimmune disease that affects approximately up to 3% of people in Canada. Men and women are affected equally. The condition causes red scaly plaques across the body.

Genital psoriasis (GP) is a type of inverse psoriasis, meaning areas like the folds in the armpits, groin, and buttocks tend to be affected. Many people with psoriasis will see these areas affected. GP is an underreported condition as patients are often too embarrassed to discuss their symptoms with their healthcare provider. The right treatment can help get rid of the itch and clear the psoriasis.

Symptoms

The skin of the genital region is very sensitive and fragile, which makes it more susceptible to being irritated by chemicals and clothes or other items. Common irritants include tampons, tight clothes, shaving, sweat, lubricants, discharge, and soaps. GP classically presents with itchiness. It usually presents as red and itchy plaques of skin that have a clear outline and do not have any scales that are commonly seen in psoriasis on other parts of the body.

In women, psoriasis affecting the vulva tends to be symmetrical (appear on both sides), with red or grey plaques affecting the labia majora.

In men, GP can affect both the skin of the scrotum and penis. The most commonly affected area is the glans penis, which is the tip of the penis. When taking a history, your healthcare provider may ask you details about whether psoriasis runs in the family, your sexual activity, and skin lesions in other areas.

Diagnosis

GP is diagnosed based on a clinical examination by your healthcare provider. Your healthcare provider may ask you about genital complaints and examine the genital area if they see psoriasis affecting other areas of your body. They may look for the presence of psoriasis in other areas of the body such as the nails, scalp, and behind the ears. GP can look like other conditions such as dermatitis, candidiasis, balanitis, vulvitis, syphilis, and certain skin cancers.

Treatment

The genitals are a particularly challenging area to treat due to their warmth, friction, and moisture. Treatment for GP is generally topical. Conservative treatment starts with mild moisturizers and avoiding things that may irritate the skin in this area. The most common option is topical corticosteroids and treatment often begins with a mild steroid. Other commonly prescribed agents include topical calcineurin inhibitors. While used for other affected areas, phototherapy is not recommended for treating psoriasis in the genital areas. If a patient fails all topical therapy, there are some cases when systemic treatments (small molecules or biologics) are initiated. It is important to note that there is no single treatment that works for everyone. You may need to try multiple treatments before finding the one that works best for you.

Lifestyle changes

There are steps you can take to avoid irritating your GP. When treating GP, use the treatment that your dermatologist specifically prescribed for that area. Treatments for other parts of the body can be harmful to the genitals. Use mild, fragrance-free cleaners in the bath. Avoid antibacterial soaps and body washes as they can irritate the delicate skin of the genitalia. Moisturize frequently especially after bathing to reduce irritation. Wear loose-fitting clothing and underwear to minimize friction.

Feeling embarrassed

GP is an embarrassing condition for many patients. Often, patients do not know where to seek professional advice or are too ashamed to disclose their situation to a healthcare provider. To make things worse, a lack of social awareness leads to people confusing GP with sexually transmitted infections. Patients may try to treat their GP with other remedies, which may exacerbate their condition. Proper communication between a team of multidisciplinary healthcare providers and patients is very important to improve patients’ quality of life.

Things to consider when being intimate

GP can have a very negative impact on quality of life. It is a condition that affects a person’s physical, psychosocial, and emotional health. psoriasis has a greater effect on general wellbeing than many chronic diseases including cardiovascular disease and diabetes. Over 80% of patients with psoriasis report challenges with their relationships with others.

Psoriasis affecting the genitals and the face may be associated with suicidal ideation and depression. In some studies, almost 10% of subjects reported a wish to be dead. A recent study on the quality of life and sexual life of patients with psoriasis concluded that patients who have genital lesions report worse quality of life than those without genital lesions, sexual distress is highest when genital skin is affected, and that patients generally believe that the attention given to sexual challenges for patients with GP by healthcare professionals is insufficient. The main factors decreasing sexual activity in patients with psoriasis are shame and embarrassment over their physical appearance, lower sexual desire, scaling skin, and the inconvenience of using topical treatments.

You can still enjoy being intimate if you have GP. You can reduce irritation by following some basic steps.  It is important to stay on schedule with the use of topical treatments. By keeping the psoriasis as clear as possible it will minimize any potential irritation from sexual activity. In a new relationship, It is important to communicate to your partner that psoriasis is not contagious and to have some conversation about the condition. If your genital skin is poorly controlled or flaring it may be wise to postpone any sexual activity that would involve that part of your body.   Psoriasis is triggered and worsened by trauma, therefore for any sexual activity, one should ensure that adequate lubrication is used. Excessive friction can exacerbate psoriasis.

References

1. Edwards SK, Bates CM, Lewis F, [et al.]. UK national guideline on the management of vulval conditions. Int J STD AIDS. 2015, 26, 611–624
2. Menter A, Korman NJ, Elmets CA, [et al.]. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photoche-
3. Bangsgaard N, Rørbye C, Skov L. Treating Psoriasis During Pregnancy: Safety and Efficacy of Treatments. Am J Clin Dermatol. 2015, 16, 389–398.motherapy. J Am Acad Dermatol. 2010, 62, 114–135.
4. Fouéré S, Adjadj L, Pawin H. How patients experience psoriasis: results from a European survey. J Eur Acad Dermatol Venereol. 2005, 19, 2–6.
5. Welsh BM, Berzins KN, Cook KA, [et al.]. Management of common vulval conditions. Med J Aust. 2003, 178, 391–395.
6. Meeuwis KAP, de Hullu JA, Massuger LFG, [et al.]. Genital psoriasis: A systematic literature review on this hidden skin disease. Acta Derm Venereol. 2011, 91, 5–11.
7. Finlay AY, Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol. 1995, 132, 236–244.
8. Gupta MA, Schork NJ, Gupta AK, [et al.]. Suicidal ideation in psoriasis. Int J Dermatol. 1993, 32, 188–190.
9. Meeuwis KAP, de Hullu JA, van de Nieuwenhof HP, [et al.]. Quality of life and sexual health in patients with genital psoriasis. Br J Dermatol.2011, 164, 1247–1255.