Can You Get Psoriasis on Your Genitals?

Genital psoriasis (PsO), also known as vulvar psoriasis, vaginal psoriasis, and penile psoriasis, may be tough to talk about, but that doesn’t make it any less real. In fact, the itchy, red skin plaques occur in the genital areas for up to two-thirds of people with psoriasis. But you might not hear about it very often—nearly half of the people with genital lesions don’t even tell their doctors.

The issue is mostly about embarrassment, says Jashin Wu, M.D., a dermatologist and voluntary associate professor in the department of dermatology at the University of Miami’s Miller School of Medicine in Florida. “Patients don’t want to discuss what’s down there, and some doctors don’t want to look or discuss what’s down there either,” he says. This lack of awareness and/or communication about genital psoriasis can result in undertreatment, making things unnecessarily worse.

If you have raw, uncomfortable skin lesions in your genital area and you suspect it’s psoriasis, use the information and advice here as a jumping off place to talk to your doctor and get the treatment you deserve.

Genital psoriasis, like all psoriasis, can take on several different forms. Inverse and plaque psoriasis are two common types of psoriasis that you may experience in the genital area, according to the National Psoriasis Foundation. Let’s take a closer look at these two types.

Inverse Psoriasis

Inverse psoriasis occurs in skin folds and may include red skin that is smooth (not scaly) and may appear tight. It may become worse with rubbing or sweating. Inverse psoriasis in the genital area may cause discomfort, pain, severe itching, and splitting of the skin.

Plaque Psoriasis

Plaque psoriasis is characterized by thickened, raised patches covered with scales (a.k.a. plaques). On Caucasian skin, the plaques may appear red with silvery-white buildup of dead skin cells. For skin of color, the plaques may be darker, and buildup of skin cells can appear purple, gray, or dark brown. Symptoms of plaque psoriasis include discomfort, pain, itching, and cracking of the skin.

According to a study in the Indian Journal of Dermatology, the most common genital site affected by plaque psoriasis in men was the scrotum, while the most common site in women was the labia majora (outer lips of the vulva).

Genital psoriasis can impact all age groups, from infants to the elderly. In infants, genital psoriasis can appear as an intense skin rash in the diaper area.

The origins of genital psoriasis are the same as those of psoriasis in general. The latest research suggests there is an interplay between genetics and the environment that causes the immune systems of those with psoriasis to be in hyper-response mode. When the body encounters a trigger of some sort, that hyperactive immune system kicks into overdrive, causing a rapid turnover and subsequent pile-up of skin cells on the skin surface that form plaques.

In other words, psoriasis is not just a skin disease; it is a whole-body condition that is driven by the immune system and happens to show up on the skin. Which areas of skin your psoriasis appears on, including the genital area, will vary from person to person and is out of your control.

People who are predisposed to psoriasis may be free of the disease until something in the environment sets off their immune system. According to the Mayo Clinic, common psoriasis triggers include:

• Certain medications

• Heavy alcohol consumption

• Infections, such as strep throat

• Injury to the skin

• Rapid withdrawal of corticosteroids

• Smoking and secondhand smoke

• Weather, especially cold

As with causes for this condition, symptoms of genital psoriasis are no different than those of psoriasis on other areas of your skin. Some of the most common psoriasis symptoms include:

• Cyclic rashes that flare for a few weeks or months and then subside

• Dry, cracked skin that may bleed

• Itching, burning, or sore skin

• Patchy rash (varies from person to person)

• Small scaling spots

The Indian Journal of Dermatology study noted that genital psoriasis often features well-defined, thin plaques with variable degrees of scale, and that symptoms such as itching and pain may worsen after sexual intercourse.

Most likely, if you have psoriasis in your genital area, you also have it in other areas; that is, it’s rare for the condition to affect only the genitals, according to the National Psoriasis Foundation. Your provider may examine the following areas to determine if you have genital psoriasis:

• Crease between the thigh and genital area

• Vulva, penis, or scrotum

• Crease between the buttocks (including the skin around the anus)

• Pubis (skin above the genitals)

• Inner and upper thigh

If your symptoms appear different from psoriasis, or appear similar to other conditions that affect the skin around the genitals, your provider might order a skin biopsy to support the diagnosis, per the Cleveland Clinic.

While there may be some similarities in the appearances of genital psoriasis and certain sexual transmitted diseases (STDs), psoriasis is not an STD. Sexually transmitted diseases are infections that are transmitted from an infected person to an uninfected person through sexual contact, per the National Institute of Allergy and Infectious Diseases. STDs are caused by bacteria, viruses, or parasites.

Psoriasis, no matter where it is located on your body, is caused by an overactive immune system. It is not contagious and cannot be spread to another person.

With genital psoriasis, the limiting factor in being sexually active is how your body (and mind) may feel. In general, there’s no reason to skip out on sex, according to Dr. Wu, as long as you take a couple of precautions.

The first has to do with your skin self-care. Because psoriasis plaques can crack open and cause bleeding (much like dry skin in the winter), “people with genital psoriasis need to be careful about the increased likelihood of fissuring (opening) of their skin,” says Dr. Wu, adding that additional communication may also be required. “Your partner might think it’s an STD, which of course it’s not, but it still has the potential to be a difficult conversation.”

Another possibly difficult conversation? Talking with a health care provider—ideally a dermatologist—about the plaques in your genital area. That can be awkward even on the best day but is absolutely necessary, says Sheryl Hoyer, M.D., an assistant professor of clinical dermatology at University of Illinois in Chicago. “Dermatologists understand psoriasis can occur on any skin,” Dr. Hoyer says. “We also realize how disabling psoriasis can be in certain areas.”

She points out that psoriasis is classified as severe when it covers more than 10% of your body surface area or if it involves specific areas, such as your genitals. “Not only are we dermatologists more likely to correctly identify [skin symptoms on the genitals] as genital psoriasis, but we also consider it to be severe psoriasis and will try to treat it aggressively,” she adds.

There’s good news, bad news here: There are effective treatments out there to help if you get genital psoriasis, says Dr. Wu, but lesions in this area can be more difficult to manage than psoriasis on other parts of the body due to the more delicate skin and the constant friction from skin rubbing against skin during daily activities like walking. Let’s look at some of the treatments your doctor might recommend.

Topical Therapies

According to the American Academy of Dermatology Association, a treatment plan may include a mild corticosteroid cream (with or without calcitriol ointment). This may be a medication you can obtain at your pharmacy without a prescription. If you are needing something stronger, a medium-strength or more potent corticosteroid may be prescribed. A stronger steroid cream will only be used for a short time to avoid any side effects.

Your doctor might also recommend a nonsteroidal topical medication, according to the National Psoriasis Foundation. For example, the topical calcineurin inhibitors Protopic (tacrolimus ointment) and Elidel (pimecrolimus cream) are approved for eczema but sometimes prescribed off-label for psoriasis, including genital psoriasis. They work by altering the immune system and are known to be a good match for delicate areas of the skin. VTAMA (tapinarof) is an aryl hydrocarbon receptor antagonist and can also be used in sensitive areas such as skin folds and genitals.

ZORYVE (roflumilast) is a phosphodiesterase-4 (PDE-4) inhibitor that is known to reduce inflammation and psoriasis symptoms. Eucrisa (crisaborole), another topical PDE-4 inhibitor that’s currently approved for eczema, was found to be well tolerated and effective in treating genital psoriasis in a randomized, double-blinded, placebo-controlled trial. The study showed that patients treated with crisaborole 2% ointment applied twice daily for four weeks demonstrated 66% improvement compared with 9% improvement among those using a placebo ointment. After eight weeks, patients in the crisaborole group continued to show improvement.

Another option is topical vitamin D. In a review of 177 articles, vitamin D products were found to be more effective than placebos at treating chronic plaque psoriasis. And treatment that combined vitamin D with a corticosteroid was more effective than either vitamin D alone or the topical corticosteroid alone. Vitamin D products have been known to cause skin burning or irritation, so you will want to work closely with your doctor when trying a vitamin D cream or ointment.

Topical coal tar medications have worked in both adults and children with genital lesions without causing significant adverse events. Because tar can irritate and dry the skin, the National Psoriasis Foundation recommends testing a tar product on a small area of the skin before applying it to larger areas.

Systemic Therapies

Previously, whole body systemic therapies were only given if genital psoriasis was severe and resistant to topical therapies. However, according to a consensus statement from the International Psoriasis Council, released in 2020 and published in the Journal of the American Academy of Dermatology, people with psoriasis that involves “special areas” including the genitals may be candidates for systemic therapy regardless of symptom severity and whether the condition responds to topical options.

One systemic treatment your doctor may prescribe is cyclosporine, which is taken orally as a pill. According to the American Academy of Dermatology Association, cyclosporine can effectively treat severe psoriasis and works rapidly. In clinical trials, 80% to 90% of patients who received cyclosporine for 12 to 16 weeks had rapid improvement.

Methotrexate is another potentially effective option for genital psoriasis, but it is associated with side effects such as stomach issues, headache, insomnia, and urinary tract infections, according to a review in the journal Dermatology and Therapy, and its use should be limited to “patients with debilitating quality-of-life impairment.”

Biologic medications have also shown success in clearing genital psoriasis. Taltz (ixekizumab), an IL-17 inhibitor approved for the treatment of moderate-to-severe psoriasis and active psoriatic arthritis, was the first biologic to show success for the treatment of genital psoriasis.

In a study published in the British Journal of Dermatology, adults with genital psoriasis were placed in random groups to receive either ixekizumab or a placebo. By week 12, 74% of those receiving ixekizumab were either clear or had minimal psoriasis compared to 8% receiving a placebo. In addition, more patients treated with the biologic reported improved sexual activity and genital itch compared with the placebo. Even better, ixekizumab showed results in as little as one week.

Beyond medication, there are additional tips and strategies to help your medication work its best and avoid irritation and flare ups.

• Eat a healthy, anti-inflammatory diet. While the effects of psoriasis are mostly visible on the outside of the body, anything you can do to decrease inflammation throughout your body can make a difference. This includes embracing a diet that keeps inflammation at bay. According to Johns Hopkins Medicine, there are certain categories of food and beverages that can make inflammation worse including alcohol, dairy, refined carbohydrates, foods with saturated and trans fats, foods high in sugar, and foods high in gluten. No one diet is recommended for psoriasis, but limiting or avoiding inflammatory foods is a great starting place.

• Lose excess weight. Taking off unwanted pounds has the potential to help your psoriasis in two different ways. First, due to the inflammatory nature of both excess weight and psoriasis, weight loss can improve your psoriasis. A meta-analysis of six randomized control trials confirmed that weight loss following lifestyle interventions (diet or physical activity) improved psoriasis compared with a control group. Weight loss can also help your medications work better. For example, obesity is associated with lower efficacy of TNF inhibitors, a class of biologic agents, and may predict biologic treatment discontinuation for those with psoriasis, according to the journal Current Obesity Reports.

• Practice gentle skin care. The American Academy of Dermatology Association recommends washing your skin with a mild, fragrance-free cleanser. It’s also recommended to avoid deodorant or antibacterial washes because these can irritate delicate skin, potentially causing flares. You can find suggestions for gentle products here. Applying a moisturizer will not address the systemic inflammation related to psoriasis, but it may make your skin smoother, more comfortable, and less likely to crack. Look for a fragrance-free moisturizer with ingredients you can pronounce. The American Academy of Dermatology advises moisturizing after bathing or when the genital area feels dry.

• Seek support. Even with the best medical team, it can be helpful to connect with someone who understands what you are experiencing. The National Psoriasis Foundation has a peer-to-peer support network that can match you with someone who you can connect with by phone, email, or text messaging. There are also Instagrammers you can follow that will get where you are coming from.

• Take precautions during sex. The American Academy of Dermatology Association has specific recommendations for how to enjoy intimacy while managing genital psoriasis. For example, there are strategies you can use to stay comfortable when you are sexually active, such as using a lubricated condom (if either the man or woman has genital psoriasis) and gently cleansing the genital area before and after sex to reduce irritation. The Association recommends postponing sex if your skin is raw or bleeding.

• Use good toilet paper. If you are living with genital psoriasis, this is no time to skimp on the bath tissue. Your dermatologist may have a recommendation for the best toilet paper brand for you, but in general, choose a toilet paper that does not irritate when wiping and does not have perfumes, which might cause an allergic reaction on sensitive skin.

• Wear loose-fitting clothing. Tight-fitting clothing can cause friction and irritation. Try choosing breathable fabric such as 100% cotton clothing. Linen and satin can also be cool choices.

If there’s one takeaway when it comes to genital psoriasis, it’s this: Psoriasis shows up in the genital area of a majority of people living with the disease, and it’s no more your fault than a patch of psoriasis on your face or elbow. Not only is genital psoriasis real, but its impact goes way beyond your physical health, affecting psychological well-being, self-esteem, and quality of life. Talk with your dermatologist about your genital lesions: You will be far from the first (or last) person to share this experience. Once your dermatologist understands what’s going on, you can come up with a treatment plan to get you back to feeling your best.