Genital Psoriasis – An Overview
Genital psoriasis is a chronic autoimmune skin condition that affects the genital area. It shares similarities with other forms of psoriasis, but its symptoms specifically manifest in the genital region. Here’s some information on its causes, symptoms, and potential treatments.
70 percent of psoriasis patients have genital involvement while 63 percent had a current or previous history. Genital psoriasis occurs in two-thirds of psoriasis patients. It involves the genital skin. It can significantly impact a patient’s psychological functions, sexual health, and quality of life.
Causes for genital psoriasis
The exact cause of genital psoriasis is unknown, but it is believed to be related to an overactive immune response. Genetic factors and a family history of psoriasis can also contribute to its development. Other factors that may trigger or exacerbate genital psoriasis include stress, infections, hormonal changes, friction, and certain medications.
- Younger age of onset of psoriasis is a cause for genital psoriasis.
- Males are more prone to genital psoriasis than females.
- More severe disease
- Involvement of the scalp, flexures, and nails
- No association with circumcision or obesity
Symptoms of genital psoriasis
The symptoms of genital psoriasis can vary from person to person and may include:
- Red patches of skin: Affected areas typically appear red, inflamed, and may be covered with silvery scales.
- Itching and burning: These symptoms are common and can cause significant discomfort.
- Dryness and cracking: The skin in the genital area may become dry and prone to cracking or fissures.
- Soreness and pain: Psoriasis lesions can be painful, especially during sexual activity or urination.
- Lesions extending beyond the genital area: In some cases, psoriasis may extend to the surrounding areas, such as the upper thighs, buttocks, or pubic region.
Genital psoriasis is characterized by erythematous, scaly plaques, on the skin also showing intrusive symptoms. The commonly affected genital areas in males are the shaft of the penis, the scrotum, and rarely the glans penis. The psoriasis of the penis shows red patches on the shaft. It has nothing to do with circumcision.
In females, the vulva, labia majora, and perineum are commonly affected. The lesions in women are well-demarcated, thin red plaques without scales. Itch is more prevailing in this type of psoriasis. The psoriasis of the vulva appears red and non-scaly, but the itch can lead to thicker scaly plaques.
Pain is debilitating with the advancing comorbidities. Sexual dysfunction is when there’s at least one disorder in the normal physiological functions regarding sexuality.
This results in dissatisfaction, mental and physical suffering, and depression or altered quality of life. Dyspareunia is a manifestation of sexual dysfunction in genital psoriasis both in men and women. 42% of the patients have complained of Dyspareunia.
Dyspareunia can be described as pain in sex or during forms of sexual stimulation. Causes of dyspareunia can be a pelvic inflammatory disease, vulvitis, herpes, irritants, surgeries, interventions, inflammation, etc many but genital psoriasis also is one definite reason.
It is experienced in both genders in general associating sexual dysfunction. Decreased sexual desire also called libido disorder is another alarming warning of genital psoriasis. Sexual dysfunction progresses very hand in hand with genital psoriasis.
Erectile dysfunction or incompetence is noticed in 15 percent of patients who reported it as a reason for their decreased sexual activity.
The risk factors for erectile dysfunction in psoriasis are lifestyle habits, anxiety, depression, cardiovascular comorbidities, endothelial inflammation, etc
Whereas premature ejaculation is complained about in the rest of the patients.
Worsening of psoriasis after intercourse and decreased frequency of intercourse are two other symptoms.
Triggers for the genital psoriasis
The psoriasis lesions are dynamic in genital psoriasis. Both genital and non-genital psoriasis progress together. Therefore the triggers also are the same.
- Stress,
- Trauma,
- Medications associated with psoriasis
- Friction during coitus
- Wearing tight-fitted clothes
- Superimposed Infections are caused by bacterial, fungal, viral, etc are triggers that cause flare-ups.
Treatments for genital psoriasis
The disease severity of other forms of psoriasis does not correlate with this, so the patient and physician estimates often differ in genital psoriasis. Furthermore, patients show reluctance to disclose their genital symptoms to the doctors. The genital psoriasis sexual frequency questionnaire is developed to assess the sexual frequency in patients.
The genital psoriasis symptoms scale is specifically produced and used in clinical practice. However secondary infections, erosion, and progressions need further investigations. Treatment for genital psoriasis is a challenge owing to the microenvironment of the genital region. It begins with educating the patient and busting their myths.
The treatment of genital psoriasis aims to relieve symptoms, reduce inflammation, and manage flare-ups. Here are some commonly used approaches:
- Topical treatments: Corticosteroid creams or ointments are often prescribed to reduce inflammation and itching. Non-steroidal alternatives like calcipotriol or calcitriol may also be used.
- Moisturizers: Regularly applying moisturizers can help alleviate dryness and reduce discomfort.
- UV phototherapy is generally not recommended.
- Systemic medications: In severe cases, oral or injectable medications such as methotrexate, cyclosporine, or biologics may be prescribed to target the underlying immune response.
- Genital-specific treatments: Specialized creams or ointments designed for use in the genital area may be recommended. These may include low-potency steroids, vitamin D analogs, or calcineurin inhibitors.
It’s crucial to consult with a dermatologist or healthcare professional for an accurate diagnosis and personalized treatment plan based on your specific condition. They can assess the severity of your psoriasis and help determine the most appropriate approach for managing your symptoms.
The degree of impact on a patient’s quality of life and psychological and sexual well-being is often disproportionate to the degree of body surface area affected. Also, since it affects the patient in multiple ways, holistic treatment is necessary. Efficacious treatments for genital psoriasis are limited.
Limitations of Psoriasis TreatmentReference: