6 Tips to Manage Genital Psoriasis
Last updated: December 2020
There is one thing we rarely admit to our doctors, and that is that we are struggling with genital psoriasis.
Sometimes I struggle to tell my husband.
I just don’t want to talk about it.
Which is, as it turns out, the worst way to approach treating it. I talked to a friend about our experiences of genital psoriasis recently and was surprised by his openness and honesty. When I asked him about it, he said that if he didn’t talk about it openly, then who would?1
I have suffered from genital psoriasis for a long time, on and off. Fortunately, it's not the persistent kind like the plaques elsewhere. I have obvious triggers that set it off, and if I manage those effectively, then it clears within a week or so.
I thought I would share both my strategies and those I learned from my friend Russ.
1. Keep the genital area clean
Sweat can be a trigger for itching. I don’t often stay sweaty for long as I live in the U.K and its pretty cold, but I know when I have psoriasis in my genital region, and it gets exposed to sweat, it gets itchy; particularly the patches between my buttocks.
Reducing the length of time sweat stays on the skin is therefore essential. I cleanse the area using only fragrance-free, and sodium laureth sulfate free (I find it really harsh) detergent. Having a bath often helps if I’m really itchy, but it must be warm and not hot. If the water is hot it makes me itchy all over so it is a definite no-no. I rarely use solutions in the bathwater, but I have heard that oatmeal and bath oils can help. I have kids and am not great at remembering to wipe slippery ointments out of the bath when I’m finished so this doesn’t work for me from a practical level.
The other thing about keeping the area clean is that it helps to reduce the risk of infection. The psoriatic skin is more likely to crack and therefore is more vulnerable to a bacterial breach (or other pathogenic microbes).
2. Air is your friend
There is one thing both Russ and I agreed on. Giving your genital a good airing is our favorite way to deal with genital psoriasis. Wearing loosely fitting tracksuit bottoms with no underwear on allows the air to move around the genital region, whether its the fact your less likely to sweat with all that airflow, the temperature shift, or an oxygen availability thing I don’t know. I just know it reduces the itching and makes everything seem better.
Sometimes I have to sit in odd positions to get the air to where it is needed, so if you live in a flat or a shared house- make sure you do this privately- a tent over your nether regions works well if your in a bedroom with no curtains or no door lock.
3. Avoid friction
Friction is the worst for psoriasis in general, but when it is in your genital region, it's hard to avoid sometimes. Wearing cycling shorts can help, as it sits neatly into creases that may rub and if they are seamless, then you don’t have any friction from the seams running either.
Pubic hair length can also help. I find when my pubic hair is long, the hair moves along the surface of my psoriasis in the pubic region and that can worsen itching. Trimming the pubic hair very short really helps with this. I have tried shaving off and waxing off all pubic hair- and while this makes applying topicals easier- the hair regrowth stubble made the itching worse too.
4. Tackle genital itching head on
I recommend speaking to your doctor first, but I will come back to that. These are my favorite at home solutions for itching, but they are highly personal. And it depends precisely where your psoriasis is.
If it's on ‘more regular’ skin ie, the skin where pubic hair lies I will use aloe vera, menthol based creams, a moisturizer containing colloidal oatmeal and hydrocortisone cream. On skin that is in skin folds like between the buttocks and between the groin and the leg, I am more apprehensive about using topical steroids without medical guidance, because the skin is thinner and because it is in a skin fold, it is also warmer; which means that creams are absorbed faster.
On the most sensitive parts of my genitals, I will always speak to a doctor before applying anything directly. This skin is so thin, delicate and rich in nerve endings you really don’t want to go wrong here. Trust me- wayward hair removal cream has taught me this lesson!
Which reminds me...cold things really can help take the heat and itch out of genital psoriasis. You can buy vaginal freezer packs for post birth wound care which are long and thin and I'm sure would also be good for wrapping between testicles too.
5. Speak to your pharmacist
This is an excellent quick stop to find several options for itching, as there are numerous over-the-counter products that you can buy. Instead of spending forever browsing the aisles I recommend chatting with the pharmacist, in many countries they are highly qualified and will know which products are best for itching in the genital region and may even suggest additional solutions.
Pharmacists are often much more convenient than visiting your doctor, as they are free to access and they usually have more accessible opening hours with no requirement for an appointment.
6. Speak to your doctor
I know you don’t want to, I get it, but it's much better than itching and having your skin crack when you bend over. The usual starting point is topicals, mild steroid creams, and U.V treatment if U.V works for the location of psoriasis. There is obviously the additional concern of sunburn which will be accommodated for by expert practitioners (and is why you should not treat this with an at home unit).
If your psoriasis is widespread or your genital psoriasis is resistant to treatment, then you may be offered oral or biologic therapy. Therefore there are loads of options for you to try at home, with the support of a pharmacist and with the help of your medical doctor. So identify what you need and come up with a plan to move forward.
Does your psoriasis management change with the seasons?