Genital psoriasis - any advice?

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Posted Wed 29 Jul 2020 22.57 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 09.34 by Kerato

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

Posted Sat 1 Aug 2020 13.49 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 16.33 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 16.53 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 17.26 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!

1 Posted Sun 9 Aug 2020 16.06 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 15.02 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 09.48 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?

Posted Wed 9 Dec 2020 18.49 by Happychappy

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.

Posted Sat 12 Dec 2020 12.41 by Kerato

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!

Posted Sat 12 Dec 2020 13.09 by Happychappy

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.

Posted Sat 12 Dec 2020 14.50 by Kerato

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.

Posted Sat 12 Dec 2020 15.15 by Happychappy

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.

Posted Sun 13 Dec 2020 11.09 by Kerato

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.

Posted Sat 26 Dec 2020 08.45 by Happychappy

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.

Posted Thu 7 Jan 2021 09.56 by Kerato

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!

Posted Thu 7 Jan 2021 18.56 by Happychappy

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.

Posted Sat 9 Jan 2021 09.18 by Mickydee

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

Posted Sun 10 Jan 2021 16.46 by Manc lad

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.
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