Genital Psoriasis: Causes, Symptoms, Treatment Options, and Flare Management

If red, scaly plaques that burn and itch appear down south in sensitive areas near your genitals, you may have genital psoriasis. This type of psoriasis is common among people with psoriasis, affecting most people with a chronic skin disease. 

Because it can be bothersome, cause embarrassment, and even be stigmatized, you may be reluctant to get it looked at or seek treatment. There are several steps you can take to treat genital psoriasis. Here’s what you need to know.

What is genital psoriasis?

Psoriasis is an autoimmune disorder where the immune system overreacts, sending skin cell growth into overdrive. This leads to symptoms like scaly patches of inflamed skin that can appear anywhere on the body–including affecting the genitals.

As many as two out of three people with psoriasis report having genital psoriasis during their lifetime, reports research. But many people may stay quiet about these down-there lesions. “Genital psoriasis is likely an under-appreciated condition. It’s a sensitive area, and it can be difficult to open up to your care provider about,” says Rachel Day, MD, FAAD, Chief Medical Officer at Zest Dermatology. 

Given the effect genital psoriasis can have on your quality of life, it’s worth speaking to a clinician about it because there are treatments that can help get your skin under control. 

Causes of genital psoriasis

Know that if you have genital psoriasis, you didn’t do anything wrong. 

Psoriasis is an autoimmune disease, which is caused by a combination of genes and environmental factors–stress, infection, weather, and tobacco use–that trigger the disease to be active. The skin condition runs in families and is not contagious.

When it comes to genital psoriasis specifically, “if you have psoriasis, you can develop genital psoriasis,” says Dr. Day. In short, psoriasis can affect the skin around your body, and that includes places like the pubic area. 

You can also experience inverse psoriasis in the genital area. This is psoriasis that occurs in body folds–like the genitals–that is exacerbated by sweat and friction.

Symptoms and diagnosis

A psoriasis lesion can look like a patch of thick, discolored, silvery-white skin. On the genitals, however, the lesions appear less scaly than in other places of the body due to the moisture in the area. “You may see pink demarcated plaques, especially in folds,” says Dr. Day. In addition, plaques appear in hair-bearing areas, including the gluteal cleft (upper part of the buttocks), mons pubis (front of the pubic area), the penile head, and scrotum, she says.

Along with lesions, additional symptoms of genital psoriasis also include the below, according to research:

• Burning
• Cracking
• Discomfort
• Itching
• Pain
• Redness
• Scaling
• Stinging

‍Diagnosing psoriasis on the genitals includes a skin examination, taking a personal health history, and may include taking a skin sample, if needed, to rule out other possible conditions. The best healthcare professional to see for a diagnosis is a dermatology provider.

If you currently have psoriasis, ideally your provider also invites you to discuss things that may be uncomfortable to talk about, says Dr. Day. “If a provider doesn’t ask, this is where self-advocacy comes in. I’d encourage patients to say ‘I’m a little embarrassed or uncomfortable, but I notice xyz,’” she says. That’s where you can talk about lesions you see or sensations of itching, irritation, burning, or pain. “If you don’t feel comfortable bringing this up, you may need to look for another place of care,” says Dr. Day. 

It’s important to get a proper diagnosis, even if you know you have existing psoriasis, as you may want to rule out other diseases that can cause lesions in the genital area, such as a sexually transmitted infection (STI) or skin conditions that may be mistaken for psoriasis like eczema, irritation from skincare products or clothing, or a yeast infection. You can also have genital psoriasis as well as another health problem, so it’s also important not to make assumptions about your symptoms and get them checked out by a qualified provider.

Effective treatment options

If you experience a genital psoriasis flare, you have options for topical cream that can be safely applied to these more sensitive areas like the pubic area or buttocks. Remember, though, that none of these treatments are designed to go inside the body (like in the vagina, for instance), they are to be used on the outer skin only.

Topical steroids

Topical corticosteroid creams are effective for reducing inflammation to calm skin. Although these are available both over-the-counter and by prescription, it’s best to consult with your dermatologist first to get their recommendations on strength to use and how long you should use it for. Steroids come with potential side effects, including skin reactions, so work with your provider closely for guidance.

Topical psoriasis prescriptions

Roflumilast cream (Zoryve) is a topical, steroid-free prescription medication that treats psoriasis to help clear lesions from the skin and decrease symptoms like itch.  “This is a newer topical that’s been shown to be safe for sensitive areas,” says Dr. Day.

Systemic psoriasis medications

There are a variety of psoriasis medications that treat moderate to severe psoriasis around the entire body and can address psoriasis in the groin. “We consider genital psoriasis in the context of a patient’s full disease. Depending on factors like the severity of symptoms and additional health conditions, systemic medications may be appropriate,” says Dr. Day.

These are available in oral or injected forms and can include steroids, retinoids, and immunosuppressant drugs like methotrexate or biologic medications. If you are noticing a worsening of your psoriasis–no matter where it’s located on your body–talk to a dermatology provider, as a change in treatment may be needed.

Managing and preventing flares

When it comes to psoriasis flare-up management–or you’re trying to avoid future flares–here’s what you can do to best care for your skin down there, Dr. Day recommends:

• Do: Regularly apply emollients to the skin in this area, which includes creams and lotions that have ingredients like glycerin and hyaluronic acid that lock in moisture. “Most people don’t think about putting moisturizer on their privates, but we can use the same skincare hygiene practices that we use on other parts of the body,” says Dr. Day. Again, use this on outer skin only.
• Don’t: Use harsh soaps. Look for soaps free of irritating ingredients like fragrances.
• Do: Wear breathable fabrics like cotton. When you’re being physically active, wear moisture-wicking fabrics.
• Don’t: Use a loofah to wash your private parts, as these can cause abrasions.
• Do: Apply petroleum jelly where needed to relieve chafing or discomfort.

Impact on quality of life

It’s probably no surprise that the location of genital psoriasis can affect your sexual health. There may be confusion among partners about if psoriasis is contagious (remember, it’s not) or if it’s a sign of a STI. (Although it’s possible to have an STI at the same time, genital psoriasis itself is not an STI.)

In addition, symptoms in sensitive areas may make you reluctant to engage in sexual activity in the first place. Four out of 10 people with genital psoriasis report pain during intercourse and three out of 10 say their psoriasis worsens after intercourse, according to earlier research. Because of that, many people are less sexually active and some report a fear of sexual relations because of their skin disease.Along with medical treatment and healthy skin habits, sexual health habits are important, too. If you’re using a lubricant, Dr. Day recommends choosing one for sensitive skin and avoiding products that create heat or have fragrances or flavors. “Be more attuned to product choices you’re using when engaging in safe sex,” she advises.

If you are experiencing symptoms of psoriasis on your pubic area or buttocks, you may have genital psoriasis. There are several effective treatments available to you. What often stands in people’s way of the proper diagnosis and treatment is shame surrounding symptoms or a reluctance to talk to providers about skin problems in sensitive areas.

Although that’s understandable, “you don’t have to be embarrassed about this. Genital psoriasis is super common–you’re not alone,” Dr. Day says. Dermatology providers have several options for treatment and they can customize an effective plan that adheres to your preferences to get you the relief you need.