Psoriasis on the Butt

Psoriasis on the buttocks causes a painful and itchy rash or scaly patches. A form of genital psoriasis, it occurs when the autoimmune disease affects the skin on the buttocks or in the skin folds around the anus.

Butt psoriasis causes itching, cracking, scaly, and bleeding skin on your buttocks, buttcrack, and anus. Psoriasis can also affect other genital tissue, including the penis, vulva, and pubic area.

Genital psoriasis can be very uncomfortable and even embarrassing. It is treated with topical steroids, prescription creams, and disease-modifying antirheumatic drugs (DMARDs).

This article discusses butt psoriasis and other types of genital psoriasis. It explains the symptoms, treatments, and self-care strategies to help you find relief from this itchy skin condition.

What Is Anal and Butt Psoriasis?

Psoriasis is an autoimmune disease that causes itchy, painful patches of skin on any part of the body. Genital psoriasis affects the skin on the buttocks, buttcrack, anus, pubic area, penis, vulva, and upper thighs.

The two main types of psoriasis that affect the skin on or around the buttocks and genitals include:

• Inverse psoriasis generally causes lesions of smooth, shiny skin in the folds, such as the gluteal cleft (butt crack), and red or purple itchy patches on and around the anus. Between 3% and 7% of people with psoriasis have inverse psoriasis.
• Plaque psoriasis causes patches of red, purple, gray, or dark brown elevated skin (plaques) with silvery, white scales of dead skin cells on the buttocks.

Symptoms of Psoriasis on the Butt

Symptoms of psoriasis in the butt and genital area include:

• Itching around the buttocks and genitals
• Pain and soreness in affected areas
• Red or purple patches of skin
  
• Scaly skin
• Skin lesions that crack and bleed
• Stinging or burning feeling

Yeast, fungal, and bacterial infections are also common with genital and butt psoriasis.

Genital psoriasis can negatively impact your sex life. It may also cause discomfort during and after sexual activity since friction, movement, and sweating all exacerbate psoriasis symptoms. It may also cause self-consciousness.

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.

How Psoriasis Affects Different Areas

How psoriasis affects the skin in and around the genital area can vary depending on the type of skin. Here is a quick look at specific types of genital psoriasis.

• Anus: Rashes at the anus can cause rectal bleeding and pain with passing stools. This delicate skin is more likely to get infected than psoriasis in other areas.
• Buttocks: Plaque or inverse psoriasis causes itching, cracking, scaly, and bleeding skin on your buttocks or gluteal cleft (buttcrack).
  
• Groin and thigh fold: 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.
  
• 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.
• 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.
• 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.
• 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
  

Causes and Risk Factors For Genital and Butt Psoriasis

Psoriasis is an autoimmune skin disease. Scientists don’t know exactly what causes it or why it spreads to the buttocks, anus, or genital areas.

Genes appear to 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.

Genital psoriasis is not contagious.

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-blockers, lithium, nonsteroidal 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.

Psoriasis or Jock Itch?

Genital 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. People with inverse psoriasis often have another type of psoriasis elsewhere on the body.

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.

Reach out to your dermatologist if you experience anal or genital symptoms. That way, your healthcare provider can determine whether symptoms are related to psoriasis, jock itch, or another skin condition.

How to Treat Genital and Butt Psoriasis

Psoriasis that appears on the buttocks, 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.

If you suspect you have psoriasis on your buttocks or genitals, talk to your healthcare provider. Psoriasis is treated with a combination of self-care strategies and prescription medications.

Topical Treatments

Applying medicated psoriasis creams, lotions, and ointments to the affected areas can help to soothe itchy, painful skin. Common topical treatments for genital psoriasis 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.

Oral Medications

Over-the-counter (OTC) medications like Tylenol (acetaminophen) or Advil (ibuprofen) may help to relieve the pain. Prescription oral medications are also used to manage symptoms of genital psoriasis and treat the underlying cause. These include:

• Corticosteroids, such as prednisone, are sometimes prescribed for short-term use during flare-ups
• Cyclosporine, an immunosuppressant that slows the growth of certain immune cells
• Methotrexate, a disease-modifying antirheumatic drug (DMARD) that inhibits an enzyme involved in the rapid growth of skin cells
• Otexlas (apremilast), a phosphodiesterase 4 (PDE4)-inhibitor, it controls inflammation within cells
• Soriatane (acitretin), an oral retinoid that controls the rate of skin cell turnover 
• Sotyktu (deucravacitinib), tyrosine kinase 2 (TYK2), a member of the Janus kinase (JAK) family
• Xeljanz (tofacitinib), a Janus kinase inhibitor that works to reduce an overactive immune response
  

Injectable Medications

Injections are often used to treat psoriasis. Your dermatologist may inject corticosteroids directly into your rash or, if your rash covers a large area, give an intramuscular steroid injection.

Psoriasis is often treated with biologic DMARDs that target specific parts of the immune system. Types of biologics include:

• Interleukin inhibitors, like Stelara (ustekinumab), Cosentyx (secukinumab), and Tremfya (guselkumab)
• T-cell inhibitors, like Orencia (abatacept)
• Tumor necrosis factor-alpha (TNF-alpha) inhibitors, such as Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab)
  

Self-Care Strategies

Psoriasis in the genital and anal areas should also be managed with self-care. The following self-care strategies can help:

• 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 the 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.
• Rinse between showers using a bidet or peri bottle—a squeeze bottle with a narrow, angled neck. Fill the bottle with warm tap water, sit on or hover over the toilet, and gently squeeze the bottle to rinse the area after bowel movements or if you get sweaty.
• Use natural oils on tender skin, including olive, coconut, or emu oil.
• Reach out to your dermatologist if psoriasis treatments irritate intimate skin areas.
• Try to manage stress, as it can make psoriasis symptoms worse. Meditating, listening to music, going for a walk, or doing yoga are all proven ways to manage and reduce stress.
  

Easing Sexual Discomfort

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.
  

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.

Summary

The buttocks, anus, gluteal cleft, and genitals can be affected by plaque psoriasis or inverse psoriasis. Noncontagious autoimmune conditions, symptoms can be painful and uncomfortable, which may lead to avoiding sexual intimacy.

There are many treatment options. A healthcare professional can help.