By Gary M. White, MD
Psoriasis is a benign but chronic autoimmune-mediated inflammatory and hyperproliferative skin condition. It affects about 1-2% of the population.
In one study of 354 psoriasis patients [J Am Acad Dermatol 2015;72;978], current genital psoriasis involvement was seen in 38% while 63% had current and/or previous involvement. Symptoms included itch (the most common, seen in 87%), dyspareunia, decreased frequency of intercourse, worsening of genital psoriasis after intercourse, and pain. These patients had significant impairment in both quality of life and sexual health. Male sex and younger age of onset were associated with the presence of genital disease.
Red, scaly papules and plaques of the glans, shaft and/or scrotum may occur in the patient with psoriasis. In women, the labia and adjacent areas may be affected. Scaling may be absent. [Acta Derm Venereol. 2011 Jan;91(1):5-11].
Loose fitting undergarments to decrease friction are important. A low to medium topical steroid (e.g. triamcinolone 0.025%) is usually quite effective. Alternatively, one may give a limited amount of a high potency topical steroid (e.g., 30 grams) for 2-3 weeks and then taper to a medium to low TS. A cream is recommended for men and either a cream or ointment for women depending upon the location. Mucosal involvement usually does better with an ointment. The patient applies it BID till clearing and then as needed. The patient should be warned about the risk of atrophy and stretch marks with prolonged use and instructed to have periods off the medication. After application, it is helpful to wear underwear to keep the steroid off the thighs--where stria may occur inadvertently.
Pimecrolimus cream or tacrolimus ointment are good potential treatments in the groin as they do not thin the skin. They are applied BID and may be used as initial treatment or as maintenance once a topical steroid has cleared the psoriasis. Calcipotriene has been used successfully in the groin. It is usually given as a cream QD to reduce the risk of local irritation or it may be combined with a topical steroid. Outside the US, tar preparations are sometimes given in combination with a TS to reduce the irritation.
Homepage | FAQs | Contact Dr. White