Genital Psoriasis in Men and Women

Sensitivity of tissues makes treatment all the more tricky

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It is one thing to have the scaly, itchy, and burning skin associated with psoriasis. It is another when it occurs on or around the genitals and interferes directly with your ability to have sex.

Genital psoriasis can affect both men and women and can arguably be worse than other forms of psoriasis given the delicate nature of the tissues involved. This is further complicated by creases and skin folds that can make treatment all the more difficult, as well as secondary infections that can occur in the moist, inflamed tissues of the vulva, penis, and rectum.

What Is Psoriasis?

Psoriasis is a common autoimmune disorder that causes the rapid buildup of cells on the surface of the skin. This accumulation of cells results in the formation of thick, silvery scales and dry, red patches that are often painful and itchy.

Psoriasis is a persistent, long-lasting disease. There may be times when the psoriasis will improve alternating with periods of worsening symptoms. Most types will go through cycles, flaring for a few weeks or months at a time and then subsiding or going into complete remission. 

There is no identifiable cause for psoriasis in the genital area. It cannot be transmitted through sexual contact, and it has no correlation to pregnancy, sexual activity, or menopause.

Signs and Symptoms of Genital Psoriasis

Symptoms of genital psoriasis are little different from those on other parts of the body. They can vary from person to person and include one or more of the following:

  • red patches of skin covered with silvery scales
  • dry, cracked skin that may bleed
  • inflammation accompanied by itching, burning, or pain
  • weeping in areas where there is tissue contraction (such as the rectum or penis)
  • the presence of secondary bacterial or fungal infections
  • swollen and stiff joints

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas of skin.

By and large, mucosal tissues inside the vagina or rectum are not affected.

Sexual Activity and Psoriasis

One of the frustrations of genital psoriasis is that the risk of flare-ups is directly linked to sexual intercourse. While a condom may help protect the genitals from psoriasis-inducing trauma, the friction of intercourse can induce an inflammatory response that may trigger an outbreak.

Genital psoriasis can interfere with sexual enjoyment both as a result of the direct discomfort and the physical appearance of the genitals themselves.

Treatment can sometimes be complicated by the fact that strong topical steroids can cause atrophy and/or thinning of the skin, a side effect which only increase the severity of pain during intercourse.

Treatment of Genital Psoriasis

While the use of stronger topical steroids is typically avoided, an over-the-counter, 1% hydrocortisone preparation or prescription-strength hydrocortisone with iodoquinol cream is usually effective in treating genital psoriasis. Non-steroidal Protopic (tacrolimus) and Elidel (pimecrolimus) may also be used.

If these remedies don't work, stronger steroids may be used sparingly and for short periods of time if under the supervision of a dermatologist.

If the entire genital area is covered with psoriasis, systemic treatment may be needed, either in the form of methotrexateacitretin, or a biologic drug such as adalimumab, certolizumab, etanercept, golimumab, infliximab, or ustekinumab.

Source:

Guglielmetti, A.; Conlledo, R.; Bedoya, A.; et al. "Inverse Psoriasis Involving Genital Skin Folds: Successful Therapy with Dapsone." Dermatol Ther.  2012;  2(1): 15.

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