Genital psoriasis - any advice?

Hi Slava,

Would it be better to communicate on this forum, that way others can benefit.

I have used Elecon and Trimovate. Trimovate seems especially effective as it is a combination of steroid, antibacterial and anti-fungal. But of course it needs to be used sparingly.

In my own case, what I have arounbd my genitals seems to be a combination of psoriasis, inverse-psoriasis and a fungal infection.

Thanks OhNo_Again,

I have tried Elocon (mematosone furoate), for about 2 weeks. As it is a strong steroid that's all the dermatologist would recommend. Also Trimovate. Neither made much of an impact.

I suspect a fungal infection kicked it off for me, but now it seems to have a life of its own!

OhNo_NotAgain?,

Do you have periods of remission where the genital psoriasis doesn't bother you? If so, how long do they last?

Also, have you tried oatmeal baths? Eating blueberries?

Thanks

Hi

Sorry to hear that you are suffering with this.

I have found diprosalic ointment to be extremely effective in this area .... well on the female side of things. I have totally cleared up areas of psoriasis in the genital and anal area with regular use of this ointment.

Good luck finding something that works for you as I know how distressing it can be!

Hi Loobizaz,

Thanks for your reply. I use Diprosalic lotion on my scalp, I didn't know there is an ointment. It is salicylate and betamethasone (a steroid). I have tried steroids so not sure if that will work for me, may have to try the vitamin D derivatives. I see the dermatologist soon so it is good to be able to mention what has worked for others so thanks agin for your reply.

Hi there,

This all sounds so familiar. Basically, I have/had the same symptoms.

For the penis, a small amount of trimovate twice a day for week 1 then once a day for week 2 clears mine up. It does though, come back a couple of times a year. Keeping it clean and wearing linen shorts helps. Airflow and all that...

As for the other genital areas, I used Lotriderm initially, to clear it up (under guidance of the dermatologist) and then Protopic 0.1% twice weekly which keeps it away. No feeling of sitting on needles or a hedgehog and for a while, I forget about it.

When COVID kicked off, I stopped using my Protopic. Of course, everything flared up and now I’ve spent weeks getting it back under control again.

Well done for talking about it. It’s more common than you think yet no-one mentions it.

Hi Jayxx,

Thanks for your contribution. I have used Trimovate, without much benefit but a recent visit to the NHS dermatologist (been a while since I could see one in person due to COVID) has led to a chnage in my treatment. I am using Elocon (mematasone furoate) once daily (morning) and 0.1% Protopic once daily (evening) for a week then 2-3x per week. This seems to be having an effect.

The discomfort/pain I get, which seems out of proprtion to the rash, may mean that there is some neuralgia so the dermatologist suggested amitriptyline (10mg) at night to deal with that. I haven't gone on the amitriptyline yet, I wonder if anyone else has experience of it?

Hi Kerato, wanted to respond and say I'm in the same boat and reading the replies were not alone. I have inverse psoriasis/intertrigo. Anal genital area and some on penis. The common theme is it will come and go. I had a great response initially with trimovate. My groins completely cleared, anal areas not. Alas, my groins have flared again but haven't responded to trimovate. I use emulsifying ointment which helps a little, and like you it's boxer shorts. It's a pest to say the least and extremely uncomfortable, even when sitting. I will contact GP tomorrow for a review. This forum really helps, especially reading about the different meds which seem to work differently for each person. Let's try to keep smiling and take care.

Hello HappyChappy,

Thanks for your reply. Mine problem on the penis has persisted despite many ointments. Niow the dermatologists is suggested a balanitis, possibly Zoon's. This was the initial diagnosis by my GP but the dermatologist thought otherwise. This is disconcerting. I may as for a secon opinion. There is a a specialist in male genital dermatology at university College Hospital, London, Professor Bunker.

My scrotum issue is down to Burning/red scrotum Syndrome, just to add to the fun!

What Joy!!!! I have red scrotum. Just rebooked dermatology review but in 3 weeks. I now find the seam in boxer short irritates. Not winning at the mo. Trying trimovate again.. This has come about the last 9 months. My father had psoriasis. I worry about steroids but needs must.

HappyChappy,

The red scrotum can result from steroid application, although prolonged use according to what I read. Mine started before I applied steroid, then I stopped when I realised that could be the wrong thing. I think something else started it, maybe a nerve thing. Interesting that you have RSS and psoriasis, so maybe there is some kind of link although they are different. In the literature one strategy for RSS is doxycycline tablets (an antibiotic but used for its anti-inflammatory properties) and amitriptyline ( a tri-cyclic antidepressant but used for its action against neuralgic pain). This works for some. I have had some success, the discomfort is less but not gone and it is still red, but may try something else. Also used are some anti-epileptic drugs, gabapentin and pregabalin, again because they can act against nerve pain. Two recent cases in the literature used Timolol (a beta blocker), used as eye drops and also for hemangiomas in children. Weird I know but Tmolol is reported to work as an ointment in RSS (but only 2 cases reported so far). Everybody is different but given my background, before retirement in biomedical science, I like to be informed and my dermatologist is OK with me mentioning these things.

My impression is that steroids, even strong steroid are not so problematical on the penis, the glans at least. Anyway that is what I take from what my dermatologist(s) have prescribed. Why not ask them at your review? Another ointment is tacrolimus/Protopic (brand name for tacrolimus). That is thought to be pretty safe, less side effects than steroids. Maybe worth discussing with your dermatologist?

Good luck.

Interestingly, when my groins settled so did the scotum. They both have flared now. I need to discuss with the dermatologist protopic. I am now wearing boxers inside out as the seams were irritating me underneath.

HappyChappy,

Yeah, underwear can be a problem. They aren't designed for comfort and seams can be irritating. Interesting that scrotum ans genital psoriasis flare together. Good luck with the dermatologist.

Hi Kerato, dermatologist changed treatment. One week synalar twice a day then second week once a day. Third and forth week Eumovate taken the same. Fifth and sixth week protopic only twice daily. . To see dermatologist 6 week review. I have to keep daily diary. If no better meds review then if needed skin biopsy. Spent nearly an hour with me. Explained the inn and outs of steroid ointment use.

Happychappy,

Glad to hear you had a good session with the dermatologist. It is important that they explain things. I had a biopsy, not fun but worth it as it excluded really nasty things. I am now down to attend a specialist male gentital dermatology clinic not far away. My diagnosis has essentially changed to balanitis on the penis, which if confimed will be treated differently. still red/burning scrotum syndrome though. The amitriptyline has helped with the pain/discomfort.

I bought a pair of silk boxers! Expensive at £35, but I find them more comfortable. You can handwash them and dry them on a radiator in an hour and put them back on!

Hi Kerato,

Balanitis is not pleasant I read, hopefully the clinic will sort it. I'm now week 3 of treatment. Things are slowly improving but a way to go. Bit of redness upper thigh which is making me wonder if that is eczerma. Same treatment anyway. I've learnt this ain't a,quick fix. I've switched to white underwear in case coloured dye is an irritant. Problem with boxers has been the seams have been irritating the perineal area and scrotum. Take care and here's to a happy healthy new year for us all.

I get the same problem every few months and find betnovate cream clears it in a few days.

Whenever I get psoriasis patches on the soft skin of my penis the only thing that clears it is Silkis calcitriol ointment (used sparingly). Patches on any other parts of my body seem to be eased with Dovobet. If all else fails maybe suggest this to your dermatologist. All the best.