How to Manage Psoriasis Flares in Sensitive Areas

When you think of psoriasis, you may picture patches of raised, red skin covered with silvery scales that occur on the elbows, knees, and scalp. But psoriasis can also affect other, more sensitive parts of the body such as the genital area, armpits, and the face, and the flares in these areas can look different and require other types of management and treatment.

“Psoriasis can [occur] anywhere; it can affect the nails, it can affect all the skin, and our joints,” says Neelam Vashi, MD, an assistant professor of dermatology at Boston University School of Medicine and a dermatologist at Boston Medical Center. “What we consider sensitive areas are the intertriginous areas [where two skin areas touch or rub together] — that would be underneath the armpits, the breasts, and the groin area.” She also notes that psoriasis on the face, which is much more apparent than flares on other areas, can often be more socially and psychologically upsetting.

Here’s what you need to know about how to manage and treat psoriasis flares in sensitive areas.

Sensitive Areas Impacted by Psoriasis

While psoriasis can occur anywhere in the body, these are the places that are commonly considered to be more sensitive that can be impacted by this inflammatory disease.

Groin, armpits, under the breasts The most common form of psoriasis is called plaque psoriasis; these dry, raised, silvery scaled patches often appear on the knees, elbows, scalp, and lower back. But another type of psoriasis, called inverse psoriasis, can appear in areas that may be more sensitive, such as the groin, armpits, or under the breasts, according to Rosalyn George, MD, a board- certified dermatologist and fellow of the American Academy of Dermatology and owner of Wilmington Dermatology Center in North Carolina.

This type of psoriasis causes smooth patches of red skin that don’t have the telltale dry scales of plaque psoriasis because it occurs in areas where there is moisture. These patches can be itchy, uncomfortable, or painful, and the inflammation can be worsened by sweat or the rubbing together of the skin. “In the areas where there are skin folds — in women in the areas beneath the breasts, in both men and women in the groin areas, and anywhere you perspire when you’re feeling warm or nervous, such as the underarms — you don’t see the accumulation of scale because of the moisture in those areas; you just see redness,” says Stephen P. Stone, MD, a professor of dermatology at Southern Illinois University School of Medicine in Springfield, Illinois.

Genital psoriasis According to the National Psoriasis Foundation (NPF), as many as two-thirds of people with psoriasis experience genital psoriasis at some point in their lives. People with genital psoriasis usually also have psoriasis in other areas of their body.

Genital psoriasis (which can either be plaque psoriasis or inverse psoriasis) can affect the following areas, according to the NPF:

• Penis, scrotum, or vulva
• Pubis (the skin above the genitals)
• Crease between the buttocks, including the area around the anus
• Inner and upper thigh

“People can experience flares in genital areas and it can be very disturbing,” says George. She notes that people with psoriasis on their genital or groin area often worry about whether it’s contagious and if they could give it to a romantic partner. “It’s not true,” reassures George. “It isn’t contagious.”

Facial psoriasis According to the NPF, approximately 50 percent of people with psoriasis experience psoriasis on their face, typically on their eyebrows, upper forehead and hairline, and in the area between the nose and upper lip. Psoriasis can also affect the skin around the ear (including the ear canal). In rare cases, psoriasis can also appear in and around the mouth or around the eyes. The psoriasis in facial areas can be inverse or plaque types.

Depending on which area of the face is affected by psoriasis and the severity of the inflammation, your dermatologist may suggest you also consult an otolaryngologist, dentist, ophthalmologist, or another healthcare specialist.

Palmoplantar psoriasis This type of psoriasis occurs on the palms of the hands and the soles of the feet. According to the NPF, palmoplantar psoriasis affects approximately 40 percent of people with plaque psoriasis, and those who have psoriasis on their palms and soles of their feet tend to not have psoriasis in other areas of their body.

This type of psoriasis can be very disruptive to patients, notes George. “Think of how much we use our hands and feet,” she says. “When you have an itchy or painful rash in those areas, it’s magnified because of how much we use our hands and feet in our daily life.”

The NPF notes that palmoplantar psoriasis can be challenging to treat since it often doesn’t respond to treatment as well as psoriasis that affects other parts of the body, though the range of medications for psoriasis continues to expand, giving doctors more tools at their disposal. People with palmoplantar psoriasis may need to try several different medications or combinations of treatments to find one that works for them.

Treatment for Psoriasis in Sensitive Areas

When it comes to treating psoriasis in these sensitive areas, the tools used will often be the same ones used to treat psoriasis in other parts of the body. “We treat it the same way though it may be different medications — with topicals, oral medications, injections — that will treat all areas,” says Vashi.

George notes that doctors will typically use milder versions of the same medications they use on areas that have thicker skin, such as the elbows or knees. “When the skin is thick I need something that’s going to penetrate, so I recommend a stronger medicine for that area, whereas the skin on our face, under the arms, and in our genital area is already thinner so we can use medicines that are less potent and still get good results,” explains George.

“Medicines for psoriasis aren’t one size fits all,” notes Lawrence Green, MD, clinical professor of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC, and fellow of the American Academy of Dermatology. “There isn’t one good medicine that’s safe for all areas of the skin.” He emphasizes that it’s important to talk with your dermatologist to make sure you’re using the best medicine for that part of the skin.

In addition to medication, George advises using gentle cleansers, avoiding scrubbing, and applying a good moisturizer that contains ceramides. “We want people to treat their skin the way they would a baby’s skin,” says George.

George also likes natural remedies such as turmeric. “Turmeric has been shown to be very helpful,” she says. People can try creams compounded in a turmeric base or take turmeric supplements, which George notes could be helpful for psoriasis overall, not just for sensitive areas. “It’s a great anti-inflammatory,” says George. Talk with your doctor about including natural remedies in your treatment plan.

Another important aspect of psoriasis management in sensitive areas is to focus on a healthy lifestyle — eating a healthy diet, getting exercise and enough sleep, reducing stress — to try to reduce the amount of flares, says George.

Bottom line: There are so many treatment options, including newer medications on the market, that if you find one doesn’t work, you can be almost certain you’re going to find another one that does, says Dr. Stone. “Work with your dermatologist and your insurance company to find what works best for you,” he says.

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