Psoriasis in Sensitive Areas

What is psoriasis?

Psoriasis is a common skin condition affecting 2-3% of the population of the United Kingdom and Ireland.

What does it look like?

Psoriasis appears as raised red patches of skin covered with silvery scales. It is very simply a speeding up of the usual replacement processes of the skin. This process is the same wherever psoriasis occurs on the body.

Psoriasis in sensitive areas

Psoriasis can affect all parts of the body but there are some area where the skin is thinner and may be more sensitive to treatment. These areas include the flexures - in skin folds, armpits, under the breast, between the buttocks and the groin and genital area - as well as the face and hairline.
Psoriasis in sensitive areas may also be referred to as: -
• Genital psoriasis
• Flexural psoriasis
• Inverse psoriasis

How does psoriasis differ in a flexural area?

Psoriasis in flexural areas often does not have the typical 'plaques' or scaliness seen in other areas and will appear as bright red, shiny patches of skin. It may be very uncomfortable and painful and may make people feel embarrassed about or avoid intimate situations.

What might trigger it?

It is not easy to pin pont what triggers psoriasis in flexural areas as it can just occur spontaneously. However, in the armpits and in the flexures and groin area psoriasis may sometimes worsen as a result of external factors. These may include tight clothing rubbing the skin, deodorants or antiperspirants, sanitary towels or tampons, harsh toilet paper, thrush and sexual intercourse.

What should I do?

It is better to seek help from your GP or Dermatologist for flexural areas, as some products are more suitable for treating these areas than others.

What treatments are available?

It is very important that you routinely use a moisturiser / emollient to make the skin more comfortable. In addition, there is a range of topical treatments available - creams and ointments - that your doctor can prescribe.
Skin in the flexural areas is thinner, and is often covered by clothing or even neighbouring skin such as the armpit. Treatment is absorbed more readily and therefore does not need to be as strong to be effective.
Topical Vitamin D creams and ointments can be very effective. The newer types are less likely to cause irritation, which has been a problem with these products in the past, making them more suitable for the treatment of sensitive areas and on the face. If you have widespread psoriasis it may now be possible to have just one treatment for all areas of the body.
Mild to moderate potency steroid creams may be recommended for flexural areas. However, care should be taken with their use in flexures as the warm, air-free environment can increase the potency and may lead to side effects such as skin thinning. It is also important that topical steroids are not used for long periods of time or without close supervision from your doctor. Treatments should never be stopped abruptly as this may trigger a rebound of your psoriasis.
Topical steroids may also be combined with anti-fungal and anti bacterial agents because infections with yeasts and bacteria are more common in sensitive areas.

How can I help myself?

When psoriasis affects the genital skin it can be most distressing and as a patient both you and your sexual partner may need reassurance and encouragement. If you and your partner are concerned or put off by genital psoriasis it may be helpful to talk together to your dermatologist of GP.
Psoriasis is not infectious and cannot be transmitted to another person by sexual contact. Using condoms may be helpful for male patients* and women can use lubricating jelly to reduce further aggravation of their condition.
* be careful if using an ointment to treat your genital psoriasis as this can reduce the effectiveness of latex condoms - use a non-latex alternative such as Durex Avanti or Pasante Unique.
• Avoid the use of all soaps, gels and scented products in the bath or shower
• Using a soft towel always pat the area dry after bathing and showering rather than rubbing vigorously
• Wear clean cotton underwear and avoid tight fitting jeans or trousers
• Women should try to wear stockings rather than tights
• Men may find boxer shorts preferable to briefs
• Do not use products prescribed for other parts of the body unless specifically directed to do so by your doctor.

Psoriasis on the face and hairline

Psoriasis on the face is relatively uncommon and plaques may be less clearly defined, which sometimes leads to confusion with eczema.
If you have scalp psoriasis you may have specific treatments prescribed by your doctor that you can also use to treat psoriasis on your hairline. If these cause irritation on your facial skin, you should talk to your doctor about an alternative treatment that is approved for use on the face. Do use lots of moisturiser to help keep the scaling under control and to keep the skin comfortable. A weak topical steroid may help and there are Vitamin D based treatments which are licensed for use on the face.

Can I use make-up to conceal the psoriasis on my hairline and face?

There are organisations that specialise in camouflage make-up, including the British Red Cross Skin Camouflage Service (www.redcross.org.uk) and the Skin Camouflage Network (www.skincamouflagenetwork.org.uk).
However, make-up could interfere with how well your topical psoriasis treatments work and this is something that should be considered very carefully and discussed with your doctor.