Psoriasis anywhere on the body can be embarrassing, frustrating and difficult to treat, but genital psoriasis can be particularly isolating because people simply don’t want to talk about health issues on the most private parts of their body.
Genital psoriasis typically presents as patches of red, dry skin on the genitals and on surrounding areas of skin. It’s not necessarily confined to the penis or vulva! It may also appear in the creases between the thighs and groin, around the anus, in the pubis area (above the genitals) and on the upper thighs.
Plus, it doesn’t look – or feel – the same on everyone. According to National Psoriasis Foundation board member Lawrence Green, M.D., it may be scaly on some people, but not scaly on others. On some people, the patches might be painful, while others experience no pain or discomfort.
The treatment options for genital psoriasis are similar to treatments for psoriasis in general, Dr. Green said in an email interview with HealthCentral. However, any topical medications used need to be very gentle, because genital skin is more sensitive than skin on other parts of the body.
Also, treatments you may have been prescribed for psoriasis in another part of your body may be unsuitable or unsafe to use on the genital area. For example, the vitamin A derivative Tazorec (tazarotene), a topical gel, can irritate the area and potentially make genital psoriasis worse. Phototherapy (UVB, PUVA or laser treatments) and strong coal tar therapy can increase your risk of developing genital cancer.
The American Academy of Dermatology (AAD) recommends mild topical steroids, calcipotriene cream, pimecrolimus cream or tacrolimus ointment, and certain biologic agents and systemic therapies for genital psoriasis.
In the first instance, your health care provider may prescribe a low-dose topical steroid, but limit its use because frequent, long-term use can thin the skin. Vitamin D compounds are a good alternative to steroid creams.
“Usually, we use topical nonsteroidal or low potency steroidal topical medications to start with to treat milder genital psoriasis because they work well and are safe,” said Dr. Green.
“If the genital psoriasis is very extensive, biologic agents in pill or injection form are sometimes used,” said Dr. Green.
Biologics, which are made from proteins, target the immune response that cause the rapid skin cell growth of psoriasis. Examples of biologic agents for psoriasis are Humira (adalimumab), Enbrel (etanercept), Remicade (infliximab), and Simponi (golimumab).
Biologics work for many people with psoriasis, but they come with two main drawbacks. They are very expensive, costing in the region of $10,000 to $30,000 per year, and they suppress the immune system, which can increase the risk of infection.
If you have moderate to severe genital psoriasis and all other treatment options have been exhausted, your healthcare provider may suggest systemic therapies, which are prescription drugs that work throughout the body. These are taken orally in liquid or pill form, or by injection.
“For patients with refractory disease which affects their quality of life, even if the extent of involvement is less than 10 percent, the AAD recommends appropriate escalation up to systemic therapies,” Jennifer Clay Cather, M.D., of Modern Research Associates, Dallas, Texas, said in an email interview with HealthCentral.
Traditional systemics include Soriatane (acitretin), cyclosporine and methotrexate. Taltz (ixekizumab), which was first approved by the FDA in March 2016 for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy, had a label update in 2018 to include data in genital psoriasis. This makes it the first – and only – treatment approved by the FDA for moderate to severe plaque psoriasis that includes genital psoriasis data on its label.
The bottom line
The first thing you should do if you have genital psoriasis is consult a board-certified dermatologist. “Genital psoriasis is readily treatable, and there is no need to suffer,” said Dr. Green. Your dermatologist will give you a thorough examination, take detailed notes of your symptoms and history of psoriasis, and recommend a treatment plan.
At home, Dr. Green recommends applying petrolatum or other ointments to soothe the affected area as required. This can also lessen discomfort during sex if applied immediately before sexual activity. “Try not to scratch the affected area, as psoriasis is known to spread to areas where you scratch,” advised Dr. Green. “Otherwise, wash yourself as you normally would and try to carry on with your day as you normally would. You can control your psoriasis – it doesn’t have to control you.