Psoriasis can affect sensitive areas of the body, such as the face, armpits, genitals and skin folds.
The skin is more sensitive in certain areas of the body than others. This includes skin folds, where the skin is thinner, such as the armpits, under the breasts, in the groin, genitals and between the buttocks.
When psoriasis occurs in these areas, you may hear it referred to as flexural’ or ‘inverse’ psoriasis. It is often described as 'high impact’, because it can affect daily life more, even when only a small area is involved.
Psoriasis in flexural areas is described separately from plaque psoriasis because the appearance is very different. It is much less scaly and may look bright red on lighter skin tones, or darker in colour on deeper skin tones, often with a smooth and shiny surface.
often does not have the typical ‘plaques’ or scaliness seen in other areas and usually appears as very bright red (or dark on darker skin tones) and shiny. It is well demarcated (easy to tell where the psoriasis ends and normal skin begins). Because psoriasis in these areas looks quite different to its typical dry and scaly appearance, it can often be mistaken for a fungal infection or other skin condition.
Psoriasis in sensitive areas may be very uncomfortable and painful, and may make people feel embarrassed about or avoid intimate situations. Psoriasis in sensitive but non-flexural areas (such as the face) may look similar to psoriasis on other parts of the body.
As with other types of psoriasis, it is not easy to pinpoint what triggers psoriasis in sensitive areas. Sometimes it happens spontaneously, or for no real reason at all. However, psoriasis in the armpits, other flexures and groin area may sometimes get worse as a result of external factors. These may include tight clothing rubbing the skin, deodorants or antiperspirants, sanitary towels or tampons, harsh toilet paper, thrush and sexual intercourse.
Sensitive psoriasis can be made worse by friction and sweating so can be particularly uncomfortable in hot weather.
It is always best to seek help from a GP or Dermatologist for psoriasis in sensitive areas. This is because psoriasis in these areas can be painful or particularly uncomfortable, can affect a person’s quality of life (such as their work, relationships and social life), and may be more prone to infection. Treatments that may have been prescribed for psoriasis on another area of the body are not always suitable for psoriasis in sensitive areas. Because of this, a separate treatment plan may be needed for these areas. Suitable treatment may only be available on prescription, and so a visit to a GP or Dermatologist is essential.
Not all topical (applied to skin ) treatments for sensitive areas are suitable to use long-term, and so even if you are getting on well with your treatment, it is a good idea to review your treatment with your doctor on a regular basis.
As with all types of psoriasis, it is important to regularly moisturise psoriasis in sensitive areas. This can help to make the skin more comfortable, and is also thought to help some topical treatments to be more effective.Sensitive areas are often covered by clothing or where skin rubs against skin, which makes them warm and moist. Because of this, treatments applied to these areas can be absorbed more easily than on other parts of the body. As a result, different or milder steroid creams are sometimes recommended for psoriasis in skin folds compared with those used elsewhere on the body.
However, care should be taken with their use in flexures as the warm environment can increase the strength and may lead to side effects such as skin thinning. Topical steroids should not be used for long periods of time or without regular reviews by your doctor. Steroid treatment should never be stopped abruptly as this may trigger a rebound of your psoriasis, and so should be ‘weaned’ off, by gradually reducing the number of doses.
Topical Vitamin D creams and ointments can be used alone or in combination with a steroid. Used alone, they have few potential side effects and so can be used for longer Some vitamin D topicals are suitable for use in sensitive areas, but some are not – so it is important to clarify this with a GP or Pharmacist.
In recent years, a group of treatments known as calcineurin inhibitors have been launched for another skin condition, called atopic dermatitis. These reduce inflammation, and may sometimes be prescribed ‘off licence’ for other inflammatory skin conditions, such as psoriasis. These can be used in sensitive areas for longer than topical steroids, and can therefore make a good alternative; although they can increase skin sensitivity to UV light, meaning exposure to the sun, sunbeds, or ultraviolet light treatment must be limited.
Anti-fungal and anti-bacterial treatments may also be prescribed, as infections are more common in sensitive areas. If present, these will need to be treated alongside the psoriasis.
When psoriasis affects the genital area it can be upsetting, and both you and your sexual partner may need reassurance. If you and your partner are concerned or put off by genital psoriasis it may be helpful to talk together to your Dermatologist or GP. Psoriasis is not contagious and cannot be transmitted to another person by sexual contact. During sex, condoms* or lubricants may help to reduce irritation of psoriasis. Tips that some people find help in the management of genital psoriasis include:
• Avoid the use of all soaps, gels and scented products in the bath or shower - replace these with soap substitutes, bath or shower emollients to cleanse but not irritate the skin
• Pat the area dry after bathing and showering rather than rubbing vigorously
• Wear cotton underwear and avoid tight fitting jeans or trousers
• Women might find stockings or hold ups more comfortable than tights
• Men may find boxer shorts more comfortable than briefs
• Do not use treatments prescribed for other parts of the body unless specifically directed to do so by your doctor.
* Be careful if using topical treatments to treat your genital psoriasis as this can reduce the effectiveness of latex condoms. Non-latex alternatives are available from most supermarkets and pharmacies.
Psoriasis on the face is less common in adults but can occur more often in children. The patches may be less clearly defined than in other types of psoriasis, which can sometimes make it harder to tell apart from eczema.
Sometimes, scalp psoriasis may form around the hairline or forehead, which may then be considered ‘facial’ psoriasis rather than ‘scalp’ psoriasis. The face is a very sensitive area and often needs a different treatment to psoriasis on the rest of the body.
If you have scalp psoriasis you may have specific treatments prescribed by your doctor that you can also use to treat psoriasis on your hairline. If these cause irritation on your facial skin, you should talk to your doctor about an alternative treatment that is approved for use on the face, such as a mild topical steroid, vitamin D treatment, or a calcineurin inhibitor. Do use lots of moisturiser to help keep the scaling under control and to keep the skin comfortable.
Some people may experience something known as sebo-psoriasis overlap. This means that some people may have a combination of two common skin conditions: seborrheic dermatitis (a type of eczema linked to yeast that normally lives on the skin) and psoriasis. When someone has features of both conditions at the same time, treatment is usually aimed at managing both, rather than treating just one of them. This helps control the different causes of the skin inflammation and improves symptoms more effectively.Can I use make-up to conceal the psoriasis on my hairline and face?
It is possible that makeup could affect the way that topical treatments work, so it is always best to check with your doctor before using any. Everyone’s psoriasis is different, and so if you are going to use a make-up product, it is a good idea to do a ‘patch test’ in a small area first, to make sure it isn’t going to make psoriasis worse or irritate the skin.
Specialist skin camouflage cover products are available to cover marks, scars or skin conditions. There are organisations who specialise in providing information on this, including how to obtain skin camouflage products, and how to colour match and apply them correctly:
The information on this page is also available in our sensitive psoriasis information leaflet.