Genital Psoriasis: A Systematic Literature Review on this Hidden Skin Disease

Abstract

It is well known that the genital skin may be affected by psoriasis. However, little is known about the prevalence and clinical appearance of genital psoriasis, and genital skin is often neglected in the treatment of psoriatic patients. We performed an extensive systematic literature search for evidence-based data on genital psoriasis with respect to epidemiology, aetiology, clinical and histopathological presentation, diagnosis and treatment. Three bibliographical databases (PubMed, EMBASE and the Cochrane Library) were used as data sources. Fifty-nine articles on genital psoriasis were included. The results show that psoriasis frequently affects the genital skin, but that evidence-based data with respect to the efficacy and safety of treatments for genital psoriasis are extremely limited. An advised treatment paradigm for genital psoriasis, based on the levels of evidence, is: first-line: (weak) topical corticosteroids; second-line: vitamin D preparations or tar-based treatments.

Genital psoriasis: a hidden multidisciplinary problem — a review of literature

“…Moreover, a suitable choice of remedies is necessary to avoid irritation in this area. The issue is further complicated due to paucity of evidence-based data on the efficacy and safety of available treatment options, originating mostly from individual case reports and case series [11]. Aside from genital lesions coexisting with severe and extensive psoriasis, treatment is generally topical.…”

“…Since psoriatic patients may present to a variety of specialists and GP is considered to be an embarrassing health condition, it is recommended to always ask about any genital complaints and examine the genital area in such patients. Dermatitis, candidiasis, squamous cell carcinoma, plasma-cell balanitis or vulvitis, lichen planus, syphilis, scabies and pediculosis pubis are conditions taken into consideration during differential diagnosis of genital skin changes [11]. GP is not exclusive for adults, it may also be seen in younger patients (Fig.…”

“…However, it should be remembered that besides irritation, the immunomodulating agents may promote allergic dermatitis, candidiasis and (re)activation of viral infections [11]. In patients with suspected opportunistic bacterial or fungal infections topical antibiotics or ketoconazole/miconazole should be implemented to prevent the Koebner effect [11]. Conservative treatment of genital psoriasis includes use of mild emollients and avoiding exposure to local irritating factors [33].…”

“…Also topical treatment with immunomodulators, pimecrolimus ointment or tacrolimus cream, was recommended in monotherapy or in combination with weak corticosteroids [30][31][32]. However, it should be remembered that besides irritation, the immunomodulating agents may promote allergic dermatitis, candidiasis and (re)activation of viral infections [11]. In patients with suspected opportunistic bacterial or fungal infections topical antibiotics or ketoconazole/miconazole should be implemented to prevent the Koebner effect [11].…”

A Pustular Psoriasis Limited to the Glans Misdiagnosed as Balanitis or Reiter's Syndrome

“…Tar may be used individually or combined with topical steroids when weak corticosteroid is insufficient [15]. Vitamin D analogues are another possible treatment for genital psoriasis, particularly male genital skin lesions [13]. Here we used moderate strength topical corticosteroid for only a short time and the improvement was great.…”