When you think of psoriasis, you may picture patches of raised, red skin covered with silvery scales on your elbows, knees, and scalp. But psoriasis can affect other more sensitive body parts too, such as the genitals, armpits, and face. Flares in these areas can look different and require other types of treatments.
“Psoriasis can [occur] anywhere; it can affect the nails, it can affect all the skin, and our joints,” says Neelam Vashi, MD, dermatologist at the Dermatology Institute of Boston and adjunct professor at Virginia Commonwealth University in Richmond. “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.”
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 on the body, there are some particularly sensitive areas that can be affected by this inflammatory disease.
Groins, Armpits, and Under the Breasts
The most common form of psoriasis is called plaque psoriasis. It often appears as dry, raised silvery or grayish-scaled patches on the knees, elbows, scalp, and lower back. But another type of psoriasis, inverse psoriasis, can occur in areas that are more sensitive, such as the groin, armpits, and 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.
Inverse psoriasis causes smooth red patches on lighter skin tones or darker brown or violet patches on darker skin tones. These patches can be itchy, uncomfortable, or painful, and the inflammation can be worsened with sweat or when your skin is rubbed together.
“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 scales because of the moisture in those areas,” says Stephen P. Stone, MD, dermatologist and professor emeritus of clinical internal medicine 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 have inverse psoriasis, so they may also have psoriasis on other areas of their body.
Genital 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 thighs
“People can experience flares in genital areas and it can be very disturbing,” says Dr. 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 in the ear canal). In rare cases, psoriasis can also appear in and around the mouth or around the eyes.
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 not to 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.”
Research suggests that people with palmoplantar psoriasis are more likely to experience a lower quality of life, compared with people with plaque psoriasis in other body parts.
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.
People with palmoplantar psoriasis may need to try several medications or combinations of treatments to find one that works for them.
Treatment for Psoriasis in Sensitive Areas
While psoriasis can pose challenges no matter where it occurs — causing symptoms such as itchiness, discomfort, and even pain — psoriasis in sensitive areas can lead to an added layer of complications.
People who experience psoriasis in prominent areas such as the face or hands may feel self-conscious, ashamed, or embarrassed. Sexual relationships may potentially be impacted in people with psoriasis on their groin or genital areas.
When treating psoriasis in sensitive areas, the tools used are often the same as those used for other parts of the body. “We treat it the same way, though it may be different medications — topicals, oral medications, injections — that will treat [different] areas,” says Dr. Vashi.
George notes that, in sensitive areas, doctors will typically use milder versions of the same medications that are used on areas with 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 faces, under the arms, and in our genital areas is already thinner, so we can use medicines that are less potent and still get good results,” explains George.
Until recently, “topical psoriasis medications weren’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. “Dermatologists would have to prescribe certain medicines for the face and sensitive areas like the groin and axilla, and a different set of medicines for other thicker, less sensitive areas of the skin — and the use of these medications would have to be time-limited.”
However, a newer generation of topical, nonsteroid creams that can be used anywhere on the body — from eyelids to elbows to groin to toes — have become available, he adds.
“These creams can be used once a day until your psoriasis goes away in a given place,” Dr. Green says. There are also over-the-counter natural remedies that may help, including olive oil, coconut oil, and oatmeal.
Focusing on a healthy lifestyle to try to reduce the amount of flares is another critical aspect of psoriasis management in sensitive areas, says George. This means eating a nutrient-dense diet, exercising, getting enough sleep, and reducing stress when possible.
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.
The Takeaway
The most common type of psoriasis typically occurs on the elbows, knees, and scalp.
Psoriasis can also affect more sensitive parts of the body, such as the groin, genitals, armpits, and under the breasts.
Most psoriasis in sensitive areas is inverse psoriasis, which may cause color changes but not scaling since it occurs in moist locations.
If you have psoriasis in a sensitive area, it may present challenges, but there are many treatment options available.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Norlin JM et al. Health-Related Quality of Life in Patients With Palmoplantar Pustulosis – a Swedish Register Study. Annals of Medicine. August 8, 2024.
Salle R et al. Psoriasis and Sexuality: Patients Express Their Feelings. Skin Health and Disease. December 2022.
Dr. Jane Yoo is an internationally recognized Korean American dual board-certified cosmetic dermatologist and Mohs surgeon practicing in New York City. She graduated with a bachelor of science in biology from Massachusetts Institute of Technology and obtained a master's degree in public policy from Harvard University.
Yoo completed her dermatology residency at Albert Einstein College of Medicine followed by a Mohs Micrographic Surgery fellowship at Yale School of Medicine. She is the founder of the Clinical Research Center of New York and conducts clinical trials for numerous skincare, pharmaceutical, and energy-based device companies.
As a spokesperson for the Skin Cancer Foundation, she is a staunch advocate for skin cancer prevention and lobbying for better sunscreen regulation in the United States. She's also an Abbott World Marathon Majors Six Star Finisher and is currently training for the Sydney Marathon.
Katherine Lee is a writer and editor who specializes in health, science, and parenting content. She has written for Verywell, where she covered school-age parenting, and worked as an editor at Parenting and Working Mother magazines. She has written and edited numerous articles and essays on science, parenting, and children's health and development for What to Expect, the American Association for the Advancement of Sciences, the American Psychological Association, and Newsweek, among others
