Genital psoriasis in men and women: diagnosis and management

What is genital psoriasis?

Genital psoriasis is a localised form of psoriasis affecting the genital area. It is a chronic inflammatory skin condition, non-contagious, presenting as red, smooth or slightly scaly patches located on the pubic area, the penis and the scrotum in men, or the vulva and surrounding area in women. The internal mucous membranes (such as the vagina) are usually not affected, but the glans may be involved. To the touch, the lesions are often supple and the patches thin, due to the local moisture. Nevertheless, the lesions can lead to fissures and cause pain, particularly with friction. In addition, genital psoriasis is often associated with other areas (knees, elbows, scalp), even though, in rare cases, the condition can be confined to the genitals (scrotum, pubic area) with no other skin symptoms. Finally, diagnosis is essentially clinical. It relies mainly on the visual appearance of the patches. Management mainly involves topical treatments (usually topical corticosteroids in the form of creams or lotions, and sometimes vitamin D derivatives). Irritating products should be avoided (alcohol-based gels, harsh soaps); choose gentle care instead. Systemic treatments (tablets or biologics) are reserved for severe or extensive forms, and are generally not prescribed for isolated genital involvement. If needed, you can easily consult a dermatologist online on Feeli, available within 12 hours and without an appointment.

How does genital psoriasis present in men?

Among men with psoriasis, 33 to 49% have genital involvement. Genital psoriasis in men affects the genital organs: the penis (shaft and glans), the scrotum and the groin folds. On the glans and scrotum, the visible signs mainly consist of red patches, sometimes with fine scaling; in uncircumcised men, redness in the folds can be intense, but often without scaling because of the moisture in this area. As for symptoms, they include: a burning sensation, itching and sometimes painful fissures. These can interfere with sexual intercourse. In terms of management, gentle treatments are preferred:

  •  Topical corticosteroids: this is the first-line treatment. Dermatologists use low- to moderate-strength creams, most often applied daily. Maintenance treatment (1 to 2 times a week) is then recommended.

  •  Vitamin D derivatives (calcipotriol): these are often combined with corticosteroids or used if they fail. They help reduce cell proliferation but can irritate the skin. They should therefore be used with caution.

  •  Moisturisers and emollients: these may be recommended to limit dryness and soothe the skin. Although they do not replace active treatment, they can relieve itching and protect the skin barrier.

  •  Appropriate hygiene: it is advisable to use gentle, non-aggressive intimate washes. The area should then be dried carefully (soft towel, or even a hairdryer on a warm setting) to limit moisture. Also, prefer cotton underwear; tight synthetic clothing should be avoided.

Finally, systemic treatments (ciclosporin, methotrexate, apremilast, biologics) are generally not indicated for isolated genital psoriasis. When skin psoriasis is widespread and extensive (or severe), they may be used to improve the genital lesions. For a diagnosis or suitable treatment, you can easily consult a dermatologist on Feeli in under 12 hours.

What are the symptoms of genital psoriasis in women?

In women, the symptoms of genital psoriasis include:

  •  Itching

  •  Burning

  •  Fissures

  •  Frequent dyspareunia (pain during intercourse)

  •  Possible involvement of the interlabial folds

These lesions can make intercourse painful. In addition, genital psoriasis in women affects the vulvar area (labia majora, pubic region). This condition is fairly common: it is estimated that a third of women with psoriasis have genital involvement. In principle, the vaginal mucosa is not affected; only the external mucous membranes (vulva) are. In all cases, genital psoriasis requires a medical diagnosis, particularly to distinguish it from a fungal infection, lichen sclerosus, contact dermatitis, candidiasis or local irritation. As with men, treatment follows the same principles: topical corticosteroids (alcohol-free creams or lotions), emollients, and vitamin D derivatives if needed.

Consult a dermatologist online to treat genital psoriasis

Genital psoriasis can have a heavy impact on quality of life and sexuality. In this context, online consultation on Feeli offers several concrete advantages. Firstly, it enables fast and discreet care. Indeed, many patients find it difficult to seek consultation when a condition affects the glans, scrotum, penis or vulva, whether out of embarrassment or fear, often unfounded, of an embarrassing diagnosis. Remote care often helps overcome this taboo, by allowing symptoms to be described in complete confidentiality. In addition, teleconsultation allows an appointment to be obtained more quickly, which is a real advantage when symptoms disrupt daily life. Teleconsultation is also suitable for many common conditions:

  •  Acne;

  •  Psoriasis

  •  Eczema;

  •  Hair loss

  •  Fungal infections (nails, skin)

  •  Hives, redness and itching

  •  Warts, cysts and benign lesions

Screening for suspicious moles sometimes requires in-person care, but this mainly depends on individual circumstances. Finally, Feeli makes ongoing follow-up simpler, particularly in the case of repeated flare-ups or sexual discomfort. This notably allows treatment to be adjusted if necessary.