Genital psoriasis

Psoriasis is a skin condition that often strikes between ages 16 and 22, with another cluster occurring between ages 57 to 60. Psoriasis is an inflammatory condition whereby the skin thickens, dries and flakes. Vulvar or genital psoriasis is where the condition impacts the genitals.

There are two types: type 1 is more severe and usually starts earlier in life. Type 1 psoriasis is harder to treat and is often seen in families. Type 2 psoriasis starts later in life, being less severe and not family-related. Within these two types there are four subtypes, with the most common being plaque psoriasis.

Between one and five per cent of the population are affected by psoriasis, so rest assured, you are definitely not alone – that is millions of people. Psoriasis most often affects the elbows, knees, trunk and scalp, but is also found in the genitals of both men and women – genital psoriasis – though it seems to affect men more than women.⁵

Usually skin takes about a month to grow and shed off, but psoriasis-affected skin turns over skin cells far quicker, in three or four days, causing the scaly appearance.

Usually in healthy skin, cells dry up and fall off by themselves, but in psoriasis, the skin cell life cycle is too fast, leaving skin a ilttle raw and unprotected from the outside world, with lumps and bumps and redness.

These symptoms are what can cause psoriasis to be uncomfortable, though usually it isn’t painful. One of the worst aspects of psoriasis is it can be a bit embarrassing, as it affects the way you are presented to the outside world, and it isn’t how you feel on the inside – this can be distressing.

What is genital psoriasis?

Genital psoriasis can appear in thigh creases, on the vulva (the outside of the outer labia), and even sometimes on the buttocks. In men it affects the scrotum, penis and also the buttocks.

Genital psoriasis looks different to regular psoriasis. Genital psoriasis presents as dry, flaky skin, but won’t be quite as red as regular psoriasis.

Regular psoriasis, by contrast, presents as scaly flakes with very red bumps and lumps. Genital psoriasis is a bit more moist, potentially more sensitive, and maybe more itchy, especially if it’s hot and you are sweaty.

The vulva is a sensitive area, so there can be more discomfort there than other areas of the body, and certainly more embarrassment.

Research has found that those afflicted with genital psoriasis suffer significant sexual distress, and that health practitioners are not addressing this element of the condition adequately. In other words, you’re on your own (with the internet!).^1,6

Symptoms of genital psoriasis

• Thickened, raised patches of white skin
• Itchy
• Areas that are irritated often – elbows, crotch, under breasts, in creases
• May only appear on the vulva
• Does not appear in the mouth or inside the vagina
• Can be red or dark red, areas of redness
• Shiny, glazed
• Fissures
• May appear concurrently with yeast infections
• Associated with metabolic syndrome

Other signs of psoriasis

• Nail pitting (like pin pricks in the nail)
• Nail flaking
• Yellow-brown spots under the nails
• Small or no nail moons
• White spots or marks

Why do I have genital psoriasis?

• Emotional stress is a key factor in the development of psoriasis, so what happened prior to or at onset?
• Poor digestion, particularly the absorption of proteins, may contribute
• Genital psoriasis may be set off by a yeast infection
• Otherwise, nobody knows! It is very mysterious.

What else could it be?

It is possible that your skin lesions could be caused by something else, like a fungus or in rare cases, skin cancers.

It is very unlikely that your psoriasis is a sexually transmitted infection (STI), as the just don’t look the same, except possibly secondary syphilis, however unlikely this may be (syphilis is not widespread). It could also be lichen planus (LSEA), pityriasis rosea or contact/seborrhoeic dermatitis from toilet paper, soap or something else you are putting on your vagina/comes into contact with your vagina.

You should also be tested for tinea genitalis, and promptly.

Factors that are associated with psoriasis include:

• Alcohol
• Digestive problems
• Skin trauma (cuts, sores, any skin opening)
• Sunburn
• Streptococcus infection
• Gluten
• Viruses
• Medication – beta blockers, terbinafine, NSAIDs, lithium, chloroquine and interferon-a

Treating genital psoriasis

The first thing to do is to understand clearly what the problem is. You can’t just throw ointment at your vagina and hope it goes away – psoriasis indicates a much deeper problem, so get yourself ready.

The most important thing before undergoing any treatment is get a proper diagnosis. You don’t want to be slapping steroid cream onto your vulva and then find out later that you had a skin cancer or ringworm – not to scare you, but you need to know precisely what it is you are dealing with.

The internet can give you clues, but a real doctor or dermatologist can quickly tell you what you have, or do not have, because there are patterns to skin conditions that are easily recognised when you look at them all the time. Don’t be embarrassed of showing a doctor your vagina – they see them all the time and they are there to help you.

After a positive diagnosis for psoriasis, your doctor will usually prescribe a topical treatment suited to delicate genital skin – often a short course of a mild corticosteroid, a vitamin D analogue such as calcipotriol (Dovonex), or a topical calcineurin inhibitor such as tacrolimus (Protopic) or pimecrolimus (Elidel). They may also suggest a little sunlight. Follow their instructions: for some people this settles it well, and it is worth a proper try.⁷

Potent steroid creams should not be used on delicate genital skin for long stretches without medical guidance, as the skin here is thin and can thin further. Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are a useful steroid-sparing option for this area. Between flares, gentle emollients and a good skincare routine help keep the skin comfortable, and some people also work with a naturopath or herbalist on gentle topical and whole-body support – but this is complementary to proper medical treatment, not a like-for-like replacement for it.

Genital psoriasis can be pretty miserable, so make sure you are taking care of your psychological wellbeing. Rest assured that genital psoriasis does not scar, and is manageable.

Short-term symptom management guidelines:

DO NOT

• Aggravate the problem with harsh soaps or disinfectants. Soap can be really drying, which you want to avoid, as your skin is dry already.
• Be gentle and keep the area from drying out further. Use a natural oil – vitamin E, almond, coconut or whatever you have around in a tiny amount to keep the area protected and soothed
• Don’t scratch – it makes it worse.
• Don’t use any creams or medicines on your genitals that have not been specifically prescribed for you by your doctor or dermatologist, as they can be too strong for thin vulva skin.

DO

• Get sun on it, often – UV light is known to help heal psoriasis, even though they’re not sure why
• Use the topical treatments your doctor prescribes for genital skin – often a vitamin D analogue (calcipotriol/Dovonex), a topical calcineurin inhibitor (tacrolimus/Protopic, pimecrolimus/Elidel), or a short course of a mild corticosteroid. Do not use the strong cream you would use on your elbow on your vulva; the skin is different.
• Keep clothes loose and wear cotton underwear where possible. Don’t run around in Lycra tights all day getting all sweaty and itchy. Wear what feels comfortable. Because this isn’t caused by something you are doing externally, you don’t have to worry so much, but the point is not to irritate the skin further.
• Take clear photographs of your genital psoriasis so you have something to compare it to, so that even the slightest of improvements can be noted. You want to know if you are even getting a little bit better. Use the same lighting and shot.
• Keep a record of the things you are trying – write a blog, a diary, or just jot them down on a notepad with dates. This helps to keep track of what’s been done, for how long, and what the results were, which is useful if it takes a long time to heal, or your treatments aren’t getting results. Psoriasis is a long-term problem that needs your attention.
• Learn how to be ok with your psoriasis. You don’t have to love it, but it needs to be ok because if it’s not, only you suffer. Find a way.

Supporting psoriasis naturopathically over the long-term

Conventional medicine mainly targets the inflammation and symptoms rather than a single underlying cause, because psoriasis has no one known cause – it is a genetically driven immune condition. That said, controlling the inflammation is the main lever we have, and it works. Alongside it, looking after the wider picture – stress, nutrition, digestion and overall health – can help you feel better and may reduce flares.

This includes managing stress, handling your emotions, getting all the nutrients you require from your food, and keeping a healthy digestive system. It might seem like basic stuff, but you’d be surprised how far we have deviated from a healthy way of living.

Because everyone is different, your psoriasis is going to be different to everyone elses, despite it looking the same. This means that your treatment is going to be specific to you, and how you manage your life – what you eat, drink, smoke and breathe – counts.

Keep clear that psoriasis is not going to disappear overnight, so don’t expect miracles. It is a chronic, relapsing condition, and settling it down usually takes sustained, consistent effort over months rather than days. Stick at it.

Because of the known link of psoriasis with stress, we need to really take a good look at your emotional life. What was going on before and around the time you started to develop symptoms? Do you have a stress management plan in your life?

Psoriasis is intrinsically stressful, so it is important to be clear which part of your stress and anxiety is linked with the psoriasis, and what is linked to other things. You might find it helpful to write this down and talk to someone else about it.

You may feel shame and anger, and this might manifest itself as depression and anxiety, and have a negative effect on your relationships. You may need emotional support, so don’t be scared to get help from a friend or a trusted professional.

Because a lot of psoriasis is genetic (which we can’t change) it is harder to treat, as the ’cause’ is in our DNA – a weak spot that leaves us open to psoriasis, which a lot of people have, but it isn’t always triggered.² What we can do, however, is work on your whole body to improve the way your cells work and try to eliminate triggers to reduce the severity and frequency of attacks.

The stronger your body and soul is, the better your chances of reducing or eliminating attacks.

Some treatment guidelines garnered from scientific studies include:

1. Gluten has been implicated³ as a trigger for some people, so reduce (eliminate) your intake of gluten and see what happens – try being gluten-free for three months, measuring your genital psoriasis (a gluten-free trial mainly helps those who also have gluten sensitivity or coeliac disease). It’s worth a try, even though for most of us eliminating wheat from our diet is hard at first – you’ll adjust (and probably lose weight and feel much better – we eat way too much bread and pasta!)
2. Increase fibre to at least 30 grams / 1 ounce per day to keep your bowels moving (supplements are fine to use, as when you eliminate wheat, you will need to replace the fibre)
3. Make sure you drink enough water to keep your bowels moving (about 2 litres/8-10 glasses a day, more if you are exercising or hot)
4. Eat plenty of colourful fresh fruit and vegetables for vitamins and minerals – at least a third of each meal should be vegetables (potatoes do not count) (one third veges, one third protein, one third complex carbs like brown rice)
5. Eat more seafood to increase omega-3 fatty acids, selenium, vitamin B12, vitamin D and zinc
6. Eat more raw nuts and seeds (peanuts do not count) – a handful of nut and seed mix is a good snack
7. Don’t eat, drink or do any activity you know aggravates your psoriasis, where possible
8. Get sun: long UV-B rays are the best, but you can talk that over with your health practitioner (they may recommend special lamps)

Can I have sex with genital psoriasis?

Yes! There is no reason why you can’t have sex unless you are in pain. It can look much worse than it feels. It would be advisable to make sure the area is free from any ointments or creams before having sex, as you don’t want those inside your vagina at all and medicine doesn’t tend to taste very sexy.

How do I talk about genital psoriasis with a sexual partner?

It can be really difficult to feel comfortable with sex when you have embarrassing genitals. Your solution might be to never let anyone near your vagina, but this isn’t the answer: genital psoriasis looks worse than it feels, and there is no reason why you can’t enjoy a satisfying sex life while you work on reducing attacks.⁴

The only way this works, however, is with a good solid chat about your genital psoriasis – get it out in the open. You do not have a disease, you are not infected – you have an inflammatory immune condition. Emotionally, genital psoriasis can be very difficult to deal with.

Feelings of shame pervade, and feeling ugly ain’t pretty, so know the facts before you start this conversation. Be frank. It is not an infection, you can’t ‘catch’ it, and it won’t hurt when you have sex (usually).

Your partner is supposed to be your greatest fan, so don’t shy away from talking about how you feel about your genital psoriasis. Shame can be greatly erased by an honest chat.

Also, if you want the lights out, say so. Better to have dark sex than no sex. Work around it.

Become more at ease with it. Look at it, touch it, together, so it takes the icky out of it. It is your body – love it unconditionally.

The psoriasis is likely to come and go, so set up some flexible ground rules you feel comfortable with, for example, if you feel uncomfortable about your partner going down on you when you have a psoriasis patch on your vulva, make that out of bounds until the situation resolves, or come to some kind of agreement you are both happy with.

Ultimately, keep trying to fix the problem, but don’t stop living because of it. It is fixable! But, it will take time and effort on your part.

So if you are stuck for what to say, something along the lines of, “I have a skin condition called psoriasis on my vulva. I am being treated for it and I am doing all I can, however sometimes it doesn’t go away. It is not an infection, it won’t affect our sex, and it doesn’t hurt” is fine. Keep it simple.

What to take away from this?

Genital psoriasis is very manageable. It might take a few goes, because there is no magic bullet and psoriasis is a long-term, relapsing condition, but with effort in the right direction you can get it under good control, with long stretches of comfortable, clear skin.

Frequently asked questions

Is genital psoriasis contagious or a sexually transmitted infection?

No. Genital psoriasis is an inflammatory immune condition, not an infection – you cannot catch it or pass it on through sex or contact. It only looks alarming. That said, get a proper diagnosis first, as a few other conditions can look similar.

What does genital psoriasis look like?

On the vulva it tends to look less scaly and red than psoriasis elsewhere – more like smooth, shiny, sometimes moist patches that can itch, especially when hot or sweaty. It affects the vulva and skin folds but not inside the vagina. Fissures (small splits) can occur.

How is genital psoriasis treated?

After a firm diagnosis, doctors usually use topical treatments chosen for delicate skin: a short course of a mild corticosteroid, a vitamin D analogue (calcipotriol), or a topical calcineurin inhibitor (tacrolimus, pimecrolimus), which are good steroid-sparing options here. Gentle skincare and avoiding irritants help too.

Can genital psoriasis be cured?

There is no permanent cure – psoriasis is a long-term, relapsing condition – but it can be controlled very well, with long stretches of clear, comfortable skin. Identifying and reducing your triggers, looking after your general health, and using the right treatment all help.

This article is general information, not medical advice. Several conditions – fungal infections, lichen planus, dermatitis and, rarely, skin cancers – can look like genital psoriasis, so get a proper diagnosis from a doctor or dermatologist before treating it. Do not use strong steroid creams on genital skin without medical guidance, as this skin is thin and easily damaged.

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