Treatment of Genital Psoriasis: A Systematic Review

Abstract

Genital psoriasis affects approximately 63% of psoriasis patients at least once in their lifetime. More than any other area on the body, genital lesions significantly impair patients’ psychologic well-being and quality of life. We aimed to systematically review the published evidence on the safety, efficacy, and tolerability of treatments of genital psoriasis and synthesize the available clinical data. A total of 1 randomized controlled trial, 11 open-label studies, and 26 case reports were included in our analysis, representing a total of 458 patients, of which 332 were adults and 126 were children. Topical corticosteroids were commonly used first-line for genital psoriasis and were well tolerated. Nonsteroidal agents, such as topical calcineurin inhibitors or vitamin D analogs, were also efficacious, but were often irritating. One systemic agent, ixekizumab, demonstrated efficacy in reducing genital psoriasis symptoms in a large, randomized, placebo-controlled trial. Various systemic and topical medications may improve genital psoriasis lesions, but there is a lack of high-quality evidence to guide clinical decision-making. Specific reporting of efficacy for genital psoriasis in larger controlled studies of psoriasis treatments are necessary to improve the available evidence regarding the optimal treatment regimen for genital psoriasis.

Psoriasis in special localizations

“…Genital skin involvement concerns approximately 63% of patients with psoriasis during the course of disease and up to 79% of patients with inverse psoriasis [24–26]. Furthermore, due to inadequate assessment and embarrassment of the patient, genital involvement remains often undiagnosed and untreated [24].…”

“…Low-potency topical corticosteroids are recommended treatment of genital psoriasis. Combination therapy with vitamin D analogues or mild tar preparations should be considered [24, 26]. Some authors suggest short-term intermittent treatment with moderate-to-potent corticosteroids to induce skin resolutions, therefore shifting towards weaker topical steroids [26, 30, 31].…”

“…Also, vitamin D analogues have proven to be effective in non-steroid topical treatment for genital skin lesions, but can cause irritation. In addition to tar preparations and vitamin D analogues, immunomodulator agents (pimecrolimus or tacrolimus) are considered to be second line therapy [24, 26, 32].…”

Secukinumab Use in Patients with Moderate to Severe Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis in Real-World Setting in Europe: Baseline Data from SERENA Study

“…PsO typically manifests as plaques that occur most commonly on the elbows and knees, but can affect any area including palms, soles, nails, scalp and genitals [16][17][18][19][20]. PsO has a reported prevalence of between 1.3% and 8.5% in the adult population of European countries [21].…”

Ixekizumab improves secondary lesional signs, pain and sexual health in patients with moderate‐to‐severe genital psoriasis

“…4 Systemic therapies are recommended when other treatment options fail, 8,9 but existing data on systemic treatments come from open-label trials or case reports. 10 Ixekizumab, a high-affinity anti-interleukin-17A monoclonal antibody, is approved for the treatment of moderate-to-severe plaque psoriasis. In a randomized, placebo-controlled study (IXORA-Q; NCT02718898) in adults with moderate-to-severe GenPs, most patients achieved complete or nearly complete resolution of GenPs during 12 weeks of ixekizumab treatment as assessed by a static Physician's Global Assessment of Genitalia (sPGA-G) 9 score of 0 or 1.…”