Genital Psoriasis: Your Questions Answered

From symptoms to treatment — here’s what you should know about this skin condition.

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What is genital psoriasis?

Genital psoriasis is an autoimmune, inflammatory condition that causes skin cells to overproduce, resulting in thick, scaly, itchy plaques located in the genital area.

Locations can include:

• the vulva or penis (usually on the tip or head)
• upper thighs
• in the skin folds between your thigh and groin
• between your buttocks

It is currently unknown why some people get psoriasis (PsO) at all, and even more unclear why some cases affect their genital areas specifically. There is some discussion that stress, genetics, and environmental conditions may play a role.

According to a 2018 research review, about 63% of people with PsO experience symptoms in their genital area once in their lifetime.

Like all types of PsO, genital PsO is not contagious. Although it can be managed effectively with a variety of over-the-counter and prescription treatments, there is currently no cure.

What does genital psoriasis look like?

Genital PsO appears as patches of raised, inflamed skin. Depending on skin tone, these patches can appear purple, pink, white, or silvery.

The skin of the genitals is usually more sensitive, so the patches may look different than they do on other parts of the body. More severe cases may have cracking in the plaques.

What are the symptoms of genital psoriasis?

Genital PsO may be painful, itchy, uncomfortable, burn, or sting. Since the skin in the genital area is more sensitive, plaques or irritation in these areas may be more painful, itchy, or bleed easier than other parts of the body, too.

It may be difficult to tell the difference between genital PsO and other skin disorders, so be sure to confirm with a healthcare professional. Even if you already have a diagnosis of PsO, there is a possibility the rash in your genital area may be something different.

If the affected skin cracks, the area around the genitals is more susceptible to bacterial and fungal infections. This may require additional treatments and support from your doctor.

What can worsen symptoms of genital psoriasis?

Several things may worsen symptoms of genital PsO:

• tight clothing
• thick, bulky clothing that causes friction
• wet clothing or damp swimwear in contact with the skin for long periods of time
• rough and poor quality toilet tissue
• menstrual products with added colors, perfumes, and dyes
• intimate or sexual contact
• friction from clothing and other accessories near the genital areas (e.g., thong underwear)
• certain soaps, lotions, and detergents

Is genital psoriasis contagious or sexually transmitted?

Genital PsO is not a sexually transmitted infection (STI). It is an autoimmune, inflammatory condition, and it is not contagious or transmitted through vaginal, oral, or anal intimate contact, bodily fluids, or the air.

You can still be intimate if you have genital PsO skin plaques, depending on how severe and how it feels for you. If it’s painful, avoid sexual friction in that area. For men with plaques on the penis, a lubricated condom can help reduce friction.

After intimacy, be sure to wash with gentle, PsO-friendly soap and gently pat the area completely dry.

How do you treat genital psoriasis at home?

If you notice a psoriasis flare starting in your genital area, these tips from the American Academy of Dermatology Association may help:

• Avoid soaps and detergents with added fragrances, colors, and dyes.
• Keep the area clean and dry.
• Be sure to gently pat dry after bathing before putting on clothes.
• Avoid rubbing, friction, or tight straps, snaps, and zippers in the affected area.
• Use high quality, soft, and absorbent toilet tissue.
• Avoid thong underwear and opt for cotton undergarments that fit well.
• Opt for loose-fitting, breathable, and quick-drying clothing whenever possible.
• Avoid antibacterial soaps.
• Keep the area well moisturized.

What are medical treatments for genital PsO?

Once a medical professional confirms your diagnosis, there are a variety of prescription treatments available. Although there is currently no cure, many of these medications are very effective. Sometimes a combination of medications is necessary to manage genital PsO.

Be sure to talk with your doctor prior to starting any over-the-counter treatments. According to the National Psoriasis Foundation, there are only two active over-the-counter ingredients approved by the Food and Drug Administration (FDA) for the treatment of PsO. This includes:

• salicylic acid
• coal tar

Some topical treatments may contain a corticosteroid, which can help decrease inflammation in the area.

Other treatments for genital PsO may include:

• calcipotriene cream
• tacrolimus ointment
• cyclosporine
• methotrexate
• tapinarof (Vtama)
• Zoryve
• a biologic or biosimilar medication

Treatments to avoid

Some over-the-counter topical ingredients used to treat PsO are not typically recommended for genital PsO, as they can irritate the thin, sensitive skin in these areas.

Over-the-counter ingredients to avoid on genital PsO include:

• capsaicin
• anthralin
• topical vitamin A
• retinoids

What is a biologic medication and when is it used to treat genital PsO?

Biologics are considered when other treatment options and medications have not effectively managed PsO plaques. They are given by injection or intravenous (IV) infusion.

Biologics used to treat PsO may include:

• certolizumab pegol (Cimzia)
• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)
• ustekinumab (Stelara)
• secukinumab (Cosentyx)
• brodalumab (Siliq)
• ixekizumab (Taltz)
• tildrakizumab-asmn (Ilumya)
• risankizumab-rzaa (Skyrizi)
• guselkumab (Tremfya)

What is a biosimilar medication and when is it used to treat genital PsO?

A biosimilar is a medication made from a natural source that is very close in structure and function to a biologic medication. According to available data, there is no meaningful difference in safety or effectiveness compared to biologics.

Although treatment of genital PsO is not well-studied, these are some biosimilars used to treat PsO:

Biosimilars to adalimumab (Humira)

• adalimumab-adaz (Hyrimoz)
• adalimumab-adbm (Cyltezo)
• adalimumab-afzb (Abrilada)
• adalimumab-atto (Amjevita)
• adalimumab-bwwd (Hadlima)
• adalimumab-fkjp (Hulio)

Biosimilars to etanercept (Enbrel)

• etanercept-szzs (Erelzi)
• etanercept-ykro (Eticovo)

Biosimilars to infliximab (Remicade)

• infliximab-abda (Renflexis)
• infliximab-axxq (Avsola)
• infliximab-dyyb (Inflectra)
• infliximab-qbtx (Ixifi)

The bottom line

There are many options for treatment and care when it comes to genital psoriasis. The most important thing is to speak with a medical professional to help find what’s best for you.