Genital psoriasis - any advice?

Hello,

I hope those who read this are not of a nervous disposition as I will be open and clear about my problem in the hope I may get help and advice or I can help others!

I am a 66 year old male who recently (Sept/Oct 2019) developed what was subsequently diagnosed as psoriasis on the glans of my penis. At first I thought it was thrush, and treated it as such but unsuccessfully. Several GP visits failed to generate a proper diagnosis. The signs and symptoms were raised areas around the urethral opening which were red. This spread to one side of the urethral opening and then two flat red areas appeared at the side and lower front of the glans. It became increasingly troublesome, sometimes really quite painful and very worrying. I am concious of it almost all the time. Finally a different GP at my surgery suggested it was Zoon's Balanitis, a form of auto-immune condition and prescribed a strong steroind ointment, mematasone furoate (Elocon) for 2 weeks, twice daily. This helped a bit with the sensations.

I then visited a dermatologists, but privately, as my NHS appointment was months away and I just couldn't wait. He diagnosed psoriasis as I had low level psoriasis in my scalp (not really prioperly diagnosed before) and red areas around my anus (again no clear diagnosis previously and not troubling me anyway), aprticulary troublesome between the anus and the scrotum. He gave me Trimovate and then 0.03% tacrolimus (Protopic), to take one after the other for about 10 days each, each twice daily to follow the Elocon. This didn't really do much.

When I saw the dermatologist under the NHS (prior to lockdown) she suggested a biopsy (gulp!). Which I had then and there (horrible!). Not nice but it did rule out malignancy or pre-malignancy, which was great, and confirmed inflammatory changes. Nothing more specific than that but maybe there isn't anything more you can tell as I don't think there is a marker for psoriasis.

Anyway, since then I have been on various regimes of 0.03% tacrolimus, 0.1% tacrolimus, steroids of various strengths with not much, if any change in the rashes or the (sometimes very) unpleasant sensations. I will be seeing the dermatologist again on August 10 for a real 'live' consultation, which may lead to changes in the treatment.

I do find it all extremely challenging. I cannot consider intercourse and my mood is very variable, sometimes really quite low. It is very hard for my wife due to my moods. I find walking, working on my allotment, even just sitting in the car can be very unpleasant (like sitting on a hedgehog, all prickly and very uncomfortable), it puts me off doing anything. I do try and carry on, although I am less active than before.

Anyway, maybe somebody can give me the benefit of any experience they have had, especially regarding:

- Any treatments that were effective for them.

- Any underwear that they can recommend. Seriously, clothing seems to be important. I wear shorts/boxer type underwear to avoid close fitting 'down there', but still struggle to find comfortable clothing.

-If anyone has or has had the swelling/redness around the urethral opening I would like to know. If so has any treatment in particular been described for that form of psoriasis?

I hope nobody has been offended by this frank post. I am not someone who is personally embarassed by this sort of thing. No reason I should be in my opinion.

I also realise women can also develop genital psoriasis, you have my sympathies if you have it no matter what gender you are! So I would welcome useful comment or contributions from anybody.

Thanks