Genital psoriasis - any advice?

Posted Wed 29 Jul 2020 10.57pm by Kerato

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

Posted Fri 31 Jul 2020 9.34am by Kerato

Hi Slava,

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

Posted Sat 1 Aug 2020 1.49pm by OhNo_NotAgain?

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.

Posted Sat 1 Aug 2020 4.33pm by Kerato

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!

Posted Sat 1 Aug 2020 4.53pm by Kerato

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

Posted Fri 7 Aug 2020 5.26pm by Loobizaz

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!

Posted Sun 9 Aug 2020 4.06pm by Kerato

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.

Posted Wed 12 Aug 2020 3.02pm by Jayxx

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.

Posted Thu 13 Aug 2020 9.48am by Kerato

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?

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