You Have Psoriasis Where?!
This chronic skin condition can pop up in odd places—here’s how to handle it.by Beth Shapouri Health Writer
Psoriasis doesn’t just pop up on our hands, arms or scalp. The truth is that the itchy autoimmune skin condition can present itself pretty much anywhere you have skin—and sometimes in the strangest areas. And it’s those tucked away, sensitive, or just plain tough-to-reach spots that are often the most difficult to treat. Here, dermatologists and real patients highlight seven lesser-known locations psoriasis can show up, plus how to deal when they do.
Not only can psoriasis land on the outside of your nose and nostrils, it can show up inside it as well. If that happens, try smoothing an over-the-counter hydrocortisone cream on the affected spot for three days or see your doc for a topical steroid medication, says Charles E. Crutchfield III, M.D., clinical professor of dermatology at the University of Minnesota Medical School in Minneapolis, who typically recommends a gentle one in the Class V or VI strength for the nose.
Then, be careful when cold season starts, as friction from blowing your nose can cause flares. If you get the sniffles, Dr. Crutchfield suggests using medicated tissues with soothing and lubricating oils. And don’t leave home without an ointment like LauriPure Balm, $17, lauripure.com, which you can be applied before putting on your COVID-19 face mask to help create a barrier that’ll hold off friction.
The Genitals and Anus
This is the absolute last place people want psoriasis plaques. In fact, patches in the groin area are most likely to impact quality of life, according to a study published in the journal Psoriasis. While avoiding tight, chafe-inducing clothes helps here, you should always consider booking a derm appointment if you’re dealing with an episode in this oh-so-tender zone. “When psoriasis occurs in sensitive areas like the anus and genitals, it’s important to use a gentle combination of mild prescription steroids and non-steroids [such as] elidel cream,” which will calm flares, says Dr. Crutchfield.
What about bathroom breaks? Susan Bard, M.D., an NYC-based board-certified dermatologist and clinical instructor at Mount Sinai Hospital, says to skip wipes (they may have fragrances and preservatives that can irritate), and instead, “use soft toilet paper.”
Psoriasis on your earlobes and behind the ears may seem run-of-the-mill, but what about inside them? If you do end up with scaly patches in and around your ears, Dr. Bard recommends seeing a dermatologist for steroid drops.
Plus, your doctor may need to remove the loose flakes associated with psoriasis in the ear canal, as she says, “The scales of psoriasis can mix with wax and create an impaction which can muffle hearing until cleaned out.”
While not one of the top spots for psoriasis, flares on the nails aren’t totally uncommon—a 2019 study in the British Journal of Dermatology found that 35% of those surveyed had nail involvement. However, nails are notoriously hard to treat since they’re so thick and tough—hey, have you ever tried to get rid of a nail fungus?
Here’s what to look out for, according to Dr. Crutchfield: “On the nails, psoriasis looks like little dimples, pits or brown spots.” Your best bet for treating it is by using a prescription medicine like a biologic that works to block the immune response. And don’t forget to apply extra moisturizer after all that COVID-19 handwashing to hold off dryness!
Psoriasis can be seen on the inside of the cheeks and the roof of the mouth and more commonly on the tongue. How they appear here is “highly variable,” according to the authors of a 2019 research review in The World Journal of Dermatology, spanning everything from white plaques to grayish white spots or scales to red throbbing ulcers.
If you develop any of those symptoms, Dr. Bard recommends going to your doctor to see about getting a steroid swish to treat, and then avoid spicy and acid foods, as they “can lead to irritation that can predispose to development of psoriatic plaques or irritate existing plaques.”
Middle of the Back
This area poses some trouble for simply being difficult to twist around and get to by yourself. Sunil Murthy, 47, from Charlotte, NC, has since gotten his flares under control with lifestyle changes including meditation. But when he experienced flares on his back in the past, buddying up with his partner was the answer to getting ointment on the dry patches. He says, “I had my wife help me with it; we made it part of our nighttime routine.”
Around the Eyes
The delicate skin on the eyelids is another spot psoriasis can and does hit. “Psoriasis patches can develop in areas of friction or trauma, so it's important to avoid eye rubbing,” says Dr. Bard. Having moisturizing eye drops on hand may help reduce flares if dry-eye is leading you to touch or rub your lids.
If you do get an patches around your eyes, Dr. Bard’s advice is to see your doctor for a prescription of low-dose topical steroids or steroid sparing agents like the immunosuppressant tacrolimus.
Psoriasis on the Genitals: Psoriasis. (2018). “The impact of genital psoriasis on quality of life: a systematic review.” ncbi.nlm.nih.gov/pmc/articles/PMC6118254/
Psoriasis on the Nails: British Journal of Dermatology. (2019). “Topology of Psoriasis in Routine Care: Results from High‐Resolution Analysis of 2009 Patients.” onlinelibrary.wiley.com/doi/full/10.1111/bjd.17403
Mouth Psoriasis: World Journal of Dermatology. (2016). “Unraveling Oral Psoriasis and Its Relationship with Geographic Tongue: A literature review.” wjgnet.com/2218-6190/full/v5/i2/84.htm