Inverse Psoriasis Involving Genital Skin Folds: Successful Therapy with Dapsone

Abstract

IntroductionInverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of the patients with psoriasis. It can comprise genital skin folds as part of genital psoriasis, and it is one of the most commonly seen dermatoses of this area. There are few evidence-based studies about the treatment of intertriginous psoriasis involving genital skin folds.Case PresentationThe authors present a 42-year-old female patient with erythematous plaques in the vulva, groin, and perianal region. The patient had previously received a broad range of topical and systemic therapies that had to be discontinued due to ineffectiveness or side effects. She was treated with 100 mg dapsone daily for 10 months, showing a significant improvement of her cutaneous and mucous lesions. Complete clearance of psoriatic lesions was observed after 4 weeks of treatment. She has remained in remission for up to 2 years, using only topical therapy with tacrolimus 0.1% and calcipotriol.DiscussionGenital psoriasis is a skin disease that causes great discomfort. It is important to include examination of the genital region and to adopt this conduct in daily clinical practice. Research in this field is still poor, making no discrimination between flexural and genital psoriasis, and is based on case series and expert opinion; therefore, empirical recommendations for the treatment of genital psoriasis remain. Dapsone has been shown to be an effective and convenient alternative for the treatment of inverse psoriasis in genital skin folds, which can provide effective control of the disease. Further studies are required to determine the efficacy and safety of current therapies, and to decide whether dapsone therapy should be considered in the management of this form of psoriasis when topical and other systemic agents are not effective.

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

“…Treatment of the sensitive genital skin is challenging, because of the unique genital environment (warmth, moisture and exposure to friction) [26]. Moreover, a suitable choice of remedies is necessary to avoid irritation in this area.…”

“…Phototherapy and laser therapy are not recommended in the genital area [34]. In sporadic cases, complete remission of genital psoriasis was documented after four weeks of treatment with oral dapsone (100 mg once a day) [6,26]. Psoriasis treatment in pregnant women is a challenge and both mother's and foetal health should be taken into consideration, when choosing a drug regimen.…”

Psoriasis inversa

“…Generell sollten die folgenden allgemeinen Faktoren berücksichtigt werden, um die Ausprä-gung und das Milieu der betroffenen intertriginösen Areale positiv zu beeinflussen: 4 Topische Glukokortikosteroide mit einem therapeutischen Index von 2,0, also einem positiven Nutzen-Risiko-Verhältnis, sind zu bevorzugen (. Tab.…”

“…Anwendung von Dapson bei Psoriasis inversa vor[4]. Dies kann zum jetzigen Zeitpunkt aber nicht empfohlen werden.…”

Status Report on the Safety of Topical Dapsone Therapy for Dermatologic Disease

“…5 Today, oral dapsone is used as a primary or adjuvant therapy in many rare and refractory dermatological conditions (Table 1). 2,3,6 Figure 1. Chemical structure of dapsone, a sulfone.…”