Identifying and Managing Psoriasis on Buttocks

Inverse psoriasis affects skin areas that rub together

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Both inverse psoriasis and plaque psoriasis cause skin lesions on the genitals and the buttocks. Plaque psoriasis can occur on any skin area of the body, including the genitals. It causes plaques on the skin (patches of elevated skin) that look red, purple, gray, or dark brown with silvery, white scales of dead skin cells.

Inverse psoriasis is a type of psoriasis that causes red, inflamed skin lesions in areas of the body where the skin folds. When inverse psoriasis or plaque psoriasis affects the genitals or buttocks, it can cause discomfort and embarrassment.

Keep reading to learn how psoriasis can affect the genitals and buttocks and how to treat itching, cracking, and bleeding skin in these private areas.

Doctor talking with patient in medical room

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What Is Psoriasis? 

Psoriasis is an autoimmune skin disease that causes the skin to develop scaly patches that can be painful and itchy. These patches come and go based on how active the disease is. Having an autoimmune disease means your immune system attacks your body rather than protecting you. It is believed that around 7.4 million Americans have psoriasis.

The most common symptom of psoriasis is plaques of inflamed skin. These may appear scaly and silvery. The affected skin might feel itchy and painful.

Psoriasis is also associated with a condition called psoriatic arthritis (PsA), which causes joint swelling, stiffness, and pain. About 30% of people with psoriasis have PsA.

Genital and Anal Psoriasis

Plaque psoriasis at the genitals is sometimes called genital psoriasis. A study from 2017 in the journal Dermatology & Therapy reported the prevalence and effect on quality of life of people with plaque psoriasis who had genital involvement. Researchers found that 70% of the study participants had genital involvement.

Among these study participants, 100% reported itch and discomfort, 95% reported redness, burning, and stinging, 85% reported pain, and 75% reported scaling. Many of the study participants reported that itch, stinging, and burning were the most bothersome symptoms.

Inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of people with psoriasis. It often affects the genital and anal areas at areas where the skin folds or creases.

It can cause ongoing discomfort to the upper thighs, pubis, the folds between the thighs and groin, the vulva, penis, anus, and buttocks. Inverse psoriasis causes dry, red, inflamed patches on the skin of these sensitive areas.

Upper thighs: Inverse psoriasis can cause red, inflamed patches on the upper thighs. This can be especially irritating when the thighs rub together with walking or running.

Pubis: The pubis, also called the pubic bone, is located just above the genitals. In this area, the skin is very sensitive. Itching and scratching can make this area even more inflamed and sore.

Folds between the thighs and groin: At the folds between the thighs and groin, psoriasis can cause the skin to crack or bleed. It might resemble a fungal skin infection or yeast infection. People of any sex can develop inverse psoriasis at the folds between the thighs and groin.

Vulva: The vulva is external genitalia in people identified as female at birth. In this area, psoriasis generally doesn’t affect the mucous membranes and will remain at the outer skin layers.

The appearance of psoriasis on the vulva is often symmetrical (affecting both sides) and appears silvery and scaly, red, or glossy red at the skin folds. It can lead to severe itchiness, dryness, and thickening of the skin.

Penis: Psoriasis patches can show up on the penis and scrotum. The scrotum is the sac of skin that hangs from the male body at the front of the pelvis. Psoriasis patches can be small, red, or purple and appear either scaly or smooth and shiny on the penis and scrotum.

Anus and buttocks: Psoriasis can cause red or purple, itchy patches at or near the anus and at the crease between the buttocks. Skin plaques at the anus can lead to rectal bleeding and pain with passing stools.

At the crease of the buttocks, there might be skin patches and red or purple discoloration. This area can be sensitive, itchy, and painful. It can be difficult to treat psoriasis at the anus and buttocks' crease. 

Because of the location of the patches, both inverse and genital psoriasis can cause sensitive areas to be itchy and sore. In addition, many of the skin lesions can become cracked, start to bleed, and cause extreme pain. And because of the location of the skin lesions, the skin can become irritated from movement and sweating.

Yeast, fungal, and bacterial infections are also common with inverse and genital psoriasis. And many people who experience psoriasis in their genital and/or anal body areas also report sexual problems related to discomfort and embarrassment.

Inverse Psoriasis vs. Jock Itch

Inverse psoriasis is sometimes confused with tinea cruris (jock itch), a fungal infection that appears in damp, moist areas of the body. Outbreaks near the groin, inner thighs, or buttocks cause circular areas of redness that flare up and peel. The skin might become cracked, and it might itch, burn, or sting.

Fortunately, jock itch isn’t a serious condition. It is temporary and treatable with over-the-counter antifungal creams and good hygiene habits.

Jock itch and inverse psoriasis are often mistaken for each other because they cause similar symptoms in the skin folds of the groin area and buttocks. Both conditions cause pain, discolored skin patches, and severe itching.

Symptoms in the genital or anal areas that don’t improve with antifungal creams and good hygiene should be looked at by a doctor. A proper diagnosis involves your doctor visually inspecting the affected areas and taking a skin sample to be examined under a microscope, if necessary.

People with inverse psoriasis often have another type of psoriasis elsewhere on the body. Reach out to your dermatologist if you experience anal or genital symptoms. That way your doctor can determine whether symptoms are related to psoriasis, jock itch, or another skin condition.

Causes and Risk Factors

Researchers don’t know exactly what causes psoriasis or what causes it to spread to the anal or genital areas. They do know that genes and the immune system play a significant part in the development of psoriasis. Many family-based studies have found that about one-third of people with psoriasis have a first-degree relative with the condition.

In addition to genes, certain environmental factors can increase your risk of psoriasis. These include:

  • Hormones: Psoriasis affects all sexes equally, but researchers have found that female sex hormones can play a part in the development of psoriasis.
  • Medications: Psoriasis is sometimes drug-induced. Medications that can lead to psoriasis include beta blockerslithiumnonsteroidal anti-inflammatory drugs, antibiotics, ACE inhibitors, and TNF inhibitors.
  • Obesity: Being overweight and inactive can increase the risk of psoriasis. Both are common in people with psoriasis.
  • Stress: Stress and psoriasis are linked. Researchers think the way your immune system responds to stressors eventually leads to the chronic inflammatory response psoriasis is known for.
  • Skin injury: Psoriasis can develop after a skin injury. This phenomenon is called Koebner’s reaction, where any skin injury—a sunburn, cut, or tattoo—can trigger psoriasis.
  • Smoking and alcohol consumption: Both smoking and alcohol have been linked to the development of psoriasis. Current and former smokers are at risk, but quitting smoking can bring down your risk. Heavy alcohol consumption has also been linked to the development of psoriasis and more severe disease course.

Treating Butt Psoriasis

The skin affected by inverse psoriasis at the buttocks is much thinner and more sensitive than other areas of the body affected by psoriasis. And while that makes the anal area more painful, thinner skin means a better treatment response. These areas need to be treated gently, but for most people, the skin will clear up quickly.

Treatment options for treating inverse psoriasis on the anus and crease of the buttocks include:

  • Mild corticosteroid creams
  • Potent corticosteroid creams: Might be used for short periods.
  • Mild coal tar: Use if recommended by a doctor.
  • Calcipotriene cream: This is a form of vitamin D used on the skin to treat plaque psoriasis.
  • Pimecrolimus cream: This is a prescription alternative to steroid creams. It can reduce symptoms such as inflammation, redness, and itching.
  • Tacrolimus ointment: This prescription ointment is used off-label to treat psoriasis. It can help to reduce red, scaly plaques associated with psoriasis.
  • Traditional disease-modifying antirheumatic drugs (DMARDs): These include methotrexate and cyclosporine. They ease symptoms by reducing the immune system’s response and slowing the growth of skin cells.
  • Biologic DMARDs: These include Cosentyx (secukinumab) and Taltz (ixekizumab). They target specific parts of the immune system responsible for psoriasis. Your doctor will prescribe these when other psoriasis treatments haven’t worked well for you.

Psoriasis in the genital and anal areas should also be managed with self-care. Self-care strategies must include:

  • Wear loose clothing and underwear. Opt for silk, linen, and cotton options over nylon and polyester.
  • Use good-quality toilet paper on sensitive skin to avoid causing damage to skin and flare-ups in your intimate areas. Avoid getting urine or feces on the affected skin.
  • Get plenty of fiber from your diet for easier bowel movements.
  • Shower quickly so you are not leaving sweat on the body for long periods. Take short showers using lukewarm water to avoid drying out the skin. Use mild, fragrance-free cleansers on delicate skin.
  • Use natural oils on tender skin, including olive and coconut oil.
  • Reach out to your dermatologist if psoriasis treatments irritate intimate skin areas.
  • Try to manage stress, as it can make psoriasis symptoms worse. Find ways to destress—meditating, listening to music, going for a walk, or doing yoga are all proven ways to manage and reduce stress.

Intimacy and Psoriasis

Psoriasis affects how a person feels about their body, especially when they are with an intimate partner. And when psoriasis plaques appear on the genital and anal areas, sexual intercourse can be painful and make psoriasis symptoms worse. These symptoms can also cause a person to feel embarrassed and anxious about intimacy.

A study reported in 2017 in the journal Dermatology & Therapy looked at the sexual health of people who experienced psoriasis in their anal and genital areas. Up to 80% reported impaired sexual experience during sexual activity, worsening symptoms after sexual activity, and decreased frequency of sexual activity.

Seventy-five percent of study participants reported they avoided sexual relationships, and 55% reported reduced sexual desire due to symptom effects and feelings about appearance. Negative physical effects reported were “mechanical friction, cracking, and pain.” Emotional effects reported included embarrassment and feeling stigmatized.

Intimacy Can Still Be Possible

If you are feeling anxious about sexual activity because of psoriasis, talk to your partner and educate them about psoriasis. Let them know that psoriasis isn’t contagious and help to put them at ease. It is always a good idea to discuss psoriasis before you are intimate, so it is not a surprise.

To reduce friction and pain during sexual activity, use lubricants during sex. Choose products labeled “cooling” over warming lubricants. Warming lubricants often contain ingredients that inflame sensitive skin and might trigger psoriasis flares.

You can also make your own lubricant using olive oil, aloe vera, or coconut oil. However, oil-based lubricants should not be used with latex condoms, as they can degrade the latex and lead to condom failure.

The American Academy of Dermatology recommends the following ways to reduce irritation with sexual intercourse.

  • Postpone sex when the skin around the genitals is raw or inflamed.
  • Before sex, gently cleanse intimate areas using mild, fragrance-free cleansers.
  • During sex, use lubricated condoms to reduce irritation in intimate areas affected by psoriasis.
  • After sex, gently wash and dry intimate areas to reduce irritation.
  • Reapply topical medications after sexual intercourse.

Following your treatment plan and taking your medications as prescribed can help to improve psoriasis symptoms regardless of where they are located on the body.

There is no cure for psoriasis, but treatment will help you to feel better and clear your skin. And when you feel better, it will be easier to be in the mood and enjoy intimate time with your romantic partner.

Frequently Asked Questions

What can I do for psoriasis on my butt?

Psoriasis that appears on the anus and the crease of the buttocks can sometimes be difficult to treat. But there are plenty of treatment options, including topical (applied to the skin) and systemic medicines (such as biologics and oral treatments).

Topicals can help to moisturize skin, relieve itch and pain, reduce skin inflammation, and slow down skin cell growth. Systemic treatments work on the entire body and act on the immune system to slow down the processes that cause excessive skin growth.

Can psoriasis cause rashes around the anus?

Inverse psoriasis generally causes lesions of smooth, shiny skin in the areas where the skin folds. It can cause red or purple itchy patches on the anus and the crease between the buttocks.

Skin plaques in these two areas can cause rectal bleeding and difficulty with passing stools. Fortunately, clear skin with inverse psoriasis is possible with appropriate treatment.

What does butt psoriasis look like?

Psoriasis on the anus and at the buttocks crease looks different than plaque psoriasis that appears on large surface body areas. Patches of inverse psoriasis appear bright red, smooth, and shiny. Skin lesions usually don’t have silvery scales or dry skin that flakes off.

Summary

The genitals, anus, and crease of the buttocks may be the sites for plaque psoriasis or inverse psoriasis, which are noncontagious autoimmune conditions. The symptoms can be painful and uncomfortable and may lead to avoiding sexual intimacy. There are many treatment options. A healthcare professional can help.

A Word From Verywell  

Inverse and genital psoriasis may have flare-ups. Any number of triggers, such as starting or stopping your medicines, injury to the skin, stress, tobacco or alcohol use, or friction on deep skin folds, can make symptoms of psoriasis worse and cause symptoms to appear in intimate body areas.

Managing and avoiding triggers can reduce the number of flares you experience. If you find that your symptoms are worsening or causing you significant discomfort, reach out to your dermatologist.

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