Overview
Genital psoriasis, also known as GenPs, is a form of psoriasis that affects the genital area. Approximately 63% of people with psoriasis experience genital involvement at some point in their lives. Unlike other forms of psoriasis, genital psoriasis often manifests as bright red, shiny patches with little to no scaling, due to the moist environment of the genital area. It can affect individuals of all ages, including infants, where it is referred to as nappy psoriasis.
Symptoms of Genital Psoriasis
Affected Sites
- Pubic Region: Psoriasis here can be treated similarly to scalp psoriasis but requires gentler handling due to the sensitivity of the skin.
- Upper Thighs: Appears as small, red, scaly patches. Friction between thighs can exacerbate irritation, which can be alleviated with emollients.
- Skin Folds Between Thigh and Groin: Typically non-scaly, reddish-white, and may crack. Misdiagnosis with thrush is possible.
- Vulva (Women): Often smooth, red, and non-scaly. Emollients can reduce irritation.
- Penis (Men): Small red patches on the glans or shaft, often shiny without scaling. Both circumcised and uncircumcised men can be affected.
- Anus: Red, non-scaly, itchy, weepy, and sore. Secondary bacterial and fungal infections are common.
- Buttocks: Can be red and non-scaly or heavily scaled.
Clinical Features
Psoriasis affects around 2% of the population and is common in the anogenital area. It can present as well-demarcated, bright red plaques that are typically non-scaly due to friction. In women, it appears symmetrically on the vulva and may extend to the labia majora. In men, it commonly affects the glans and the corona of the penis, with scaling more common in circumcised men. Psoriatic napkin eruption is common in children under two years and usually resolves within a year.
Causes of Genital Psoriasis
Genital psoriasis is an autoimmune condition triggered by an overactive immune system, leading to rapid skin cell turnover and inflammation. Specific triggers include:
- Bacterial and Yeast Infections: Such as Candida albicans.
- Skin Injury: Known as the Koebner phenomenon.
- Irritants: Including urine, feces, tight clothing, and friction from sexual intercourse.
Diagnosis of Genital Psoriasis
Diagnosis is primarily clinical, based on the characteristic appearance of the lesions. A physical examination by a healthcare provider, often a dermatologist, is usually sufficient. In cases of diagnostic uncertainty, a skin biopsy may be performed to rule out other conditions. Laboratory tests like swabs are rarely necessary unless an infection is suspected.
Treatment of Genital Psoriasis
Topical Treatments
- Corticosteroid Creams: Low to moderate potency steroids can reduce inflammation and itching.
- Coal Tar Preparations: Mild formulations can be used cautiously to avoid irritation.
- Vitamin D Analogues: Calcipotriol may be effective but can irritate sensitive skin.
- Calcineurin Inhibitors: Tacrolimus and pimecrolimus are alternatives to steroids but can cause burning sensations and reactivation of infections.
Systemic Treatments
- Oral Medications: Such as methotrexate or cyclosporine for severe cases.
- Biologics: Recent studies show efficacy in using biologics like ixekizumab for rapid improvement.
Treatments to Avoid
- Dithranol and Retinoids: Often too irritating for sensitive genital skin.
- UV Light Therapy: Increased risk of skin cancer in genital areas.
- Strong Coal Tar: Potential carcinogenic risk.
Lifestyle and Home Remedies
- Emollients: Keep skin moisturized to reduce irritation and scaling.
- Loose Clothing: To minimize friction and irritation.
- Gentle Cleansers: Avoid perfumed or antibacterial soaps that can aggravate symptoms.
- Barrier Creams: Protect skin from irritants like urine and feces.
Coping and Support
Genital psoriasis can significantly impact quality of life and sexual well-being. Open communication with healthcare providers and partners is crucial for managing the condition. Emotional support from mental health professionals can also be beneficial.
References
American Academy of Dermatology (AAD). (2022). Genital psoriasis: Overview and management. Retrieved from https://www.aad.org
Cleveland Clinic. (2023). Psoriasis: Symptoms, causes, and treatments. Retrieved from https://my.clevelandclinic.org
DermNet NZ. (2023). Genital psoriasis. Retrieved from https://dermnetnz.org/topics/genital-psoriasis
