Introduction
Methods
Results
Sources | Study characteristics | Treatments and outcomes | ||||||
---|---|---|---|---|---|---|---|---|
Study design, level of evidence | Type of psoriasis | Site | Age (years) | Cohort (M/F) | Successful (side effects) | Unsuccessful (side effects) | Notes | |
J Fam Pract 2016 [41] | Case report, 5 | Plaque psoriasis | Groin | 45 | 1 M | Triamcinolone cream, clobetasol ointment | 1% hydrocortisone cream, topical antifungals, oral antifungals | 90% improvement after 1 month, 95% improvement after 2 months |
Albert et al. [14] | Case report, 5 | Plaque psoriasis | Anogenital area, genitocrural folds | 71 | 1 F | Oral doxepin, methotrexate 7.5–10 mg/week (GI disturbance) | Mild to ultra-potent topical corticosteroids, topical tacalcitol, topical doxepin, twice weekly PUVA for 2 months, topical 0.1% tacrolimus (extreme irritation, worsening of pruritus) | Oral doxepin partially helpful in alleviating itching, methotrexate improved genitocrural folds but abandoned because of GI disturbance |
Albert et al. [14] | Case report, 5 | Plaque psoriasis | Groin, genitalia extending to perianal and natal cleft | 77 | 1 F | – | Clomitrazole 1%, hydrocortisone 1% | Minimal improvement |
Bissonnette et al. [33] | Open-label case series, 4 | Plaque psoriasis | Penis, scrotum | 42 (29–70) | 12 M | Topical 0.1% tacrolimus twice daily (mild pruritus or burning sensation of limited duration) | – | Mean genital PASI decreased from 15.8 to 1.2 after 8 weeks |
Cassano et al. [26] | Open-label case series, 4 | Plaque psoriasis | Genitalia | 18+ | 9c | Efalizumab 1 mg/kg weekly | – | Considerable improvement in genital lesions after 12 weeks |
Fischer et al. [16] | Open-label case series, 4 | Plaque psoriasis | Vulva | 33 (15–56) | 8 F | TCS, 2% LPC, topical calcipotriol | – | Resolution of vulvitis |
Foureur et al. [39] | Case report, 5 | Napkin psoriasis | Diaper area | 77 | 1 F | Betamethasone 0.05% cream | Bifonazole cream daily | Cured in 1 month |
Foureur et al. [39] | Case report, 5 | Napkin psoriasis | Diaper area | 87 | 1 M | Bifonazole cream daily | – | Improved in 1 month |
Foureur et al. [39] | Case report, 5 | Napkin psoriasis | Diaper area | 100 | 1 F | Betamethasone 0.05% cream | – | Cured in 1 month |
Foureur et al. [39] | Case report, 5 | Napkin psoriasis | Diaper area | 87 | 1 F | Bifonazole cream daily, oral fluconazole 100 mg daily | – | Improved with fluconazole after 1 month |
Guglielmetti et al. [23] | Case report, 5 | Plaque psoriasis | Vulva, groin, perianal region | 42 | 1 F | Dapsone 100 g daily, mycophenolate mofetil 500 mg twice daily | 20 mg methotrexate weekly (UTI) | Complete clearance after 4 weeks of dapsone, remission for 2 years using topical tacrolimus 0.1% and calcipotriol. Slow improvement with mycophenolate mofetil after 2 months, partial therapeutic response with methotrexate, stopped at 4 months |
Jemec et al. [15] | Open-label case series, 4 | Plaque psoriasis | Glans penis, inner fold of prepuce | 43 | 3 M | Topical cyclosporine solution 100 mg/ml three times daily | – | Mean baseline scorea decreased from 4.8 to 0.8 after 8 weeks, cyclosporine well tolerated |
Ješe et al. [24] | Case report, 5 | Plaque psoriasis | Glans, foreskin, gluteal fold | 37 | 1 M | Adalimumab 40 mg every 2 weeks | Topical pimecrolimus, topical corticosteroids, methotrexate 15 mg weekly (nausea, vomiting, headache, insomnia) | Near complete regression at 90 days, complete clearance at 6 months |
Kapila et al. [18] | Open-label case series, 4 | Plaque psoriasis | Vulva | 30 (2–84) | 145 F | Methylprednisolone aceponate 0.1% (110), 2% LPC (118), hydrocortisone 1% (94), calcipotriol 0.05% (10), betamethasone dipropionate 0.05% (7), betamethasone dipropionate 0.05% + calcioptriol 0.05% (4), UVB phototherapy (3), clioquinol 1% (1), clobetasol propionate 0.05% (1), methotrexate (1) | Methylprednisolone aceponate 0.1% (7), 2% LPC (5), hydrocortisone 1% (6) | 93.8%responded to topical treatment |
Martin-Ezquerra et al. [46] | Open-label case series, 4 | Plaque psoriasis | Intertriginous folds | 18+ | 8 M/7 F | 0.1% tacrolimus ointment twice daily | – | Improvement as early as day 15, mean total scoreb from 6.88 to 0.37 after 60 days |
Meeuwis et al. [17] | Open-label case series, 4 | Plaque psoriasis | Genitalia | 50 (20–80) | 25 M/17 F | Low-potency corticosteroid cream with (18) and without (16) vitamin D analog ointment, moderate-potency corticosteroid cream (5), daily tacrolimus with low-potency corticosteroid cream (2), alternating mild and higher potency corticosteroid cream (1) | – | Significant improvement in PASI, IA, SUM, DLQI, FSDS, sQoL-M |
Quan et al. [43] | Case report, 5 | Pustular psoriasis | Glans penis, penile shaft | 23 | 1 M | Oral itraconazole 200 mg bid, triamcinolone, desonide, mometasone furoate, baking soda preparation | Hydrocortisone 1%, coal tar 2%, naftifine hydrochloride | Some improvement with itraconazole, minimal improvement with hydrocortisone and coal tar |
Rallis et al. [47] | Open-label case series, 4 | Plaque psoriasis | Glans penis, scrotum | 37 (22–72) | 7 M | 0.1% tacrolimus ointment twice daily for 10 days, then every 7 days thereafter | – | Complete clearance after 3 weeks, 43% still clear at 12 weeks |
Ryan et al. [50] | Randomized, placebo-controlled phase III clinical trial, 1 | Plaque psoriasis | Genitalia | 43 (19–77) | 56 M/19 F | Ixekizumab 160 mg at week 0, then 80 mg every 2 weeks thereafter | – | Significant improvement in genital psoriasis symptoms compared with placebo as measured by sPGA-G 0/1 (74% vs. 8%), GenPS-SFQ item 2 score 0/1 (78% vs. 21%), and ≥ 3 point reduction in genital itch NRS (60% vs. 8%) |
Sezer et al. [51] | Case report, 5 | Plaque psoriasis | Glans penis, penile shaft | 26 | 1 M | Betamethasone valerate, topical 5% salicylic acid | – | Marked regression of the lesions |
Shimamoto et al. [25] | Case report, 5 | Pustular psoriasis | Groin | 80 | 1 M | Oral chlorpromazine 125 mg/day | Corticosteroids, antibiotics, griseofulvin | Resolution of skin symptoms several weeks after initiation of treatment, associated with reduction in manic symptoms |
Singh et al. [22] | Case report, 5 | Pustular psoriasis | Glans penis | 37 | 1 M | Dapsone 100 mg daily, doxycycline, metronidazole, penicillin, topical steroid ointments | – | Complete clearance in 4 weeks with dapsone, maintenance with dapsone 50 mg daily |
Winrauch et al. | Case report, 5 | Plaque psoriasis | Labium majus | 22 | 1 F | Betametasone 17-valerate three times daily | – | Clearance of lesions |
Yao et al. [40] | Case report, 5 | Plaque psoriasis | Glans penis | 37 | 1 M | Tacrolimus 0.1% ointment twice daily | Topical ketoconazole cream for 2 weeks | Resolution of lesions after 3 weeks |
Zampetti et al. [48] | Case report, 5 | Plaque psoriasis | Glans penis | 45 | 1 M | Topical tacrolimus 0.1% ointment daily | – | Complete resolution after 3 weeks |
Medication | Successful | Unsuccessful |
---|---|---|
Zinc paste | Fergusson et al. [35] | |
Salicylic acid | Andersen et al. [28] | |
Aniline dye | Andersen et al. [28] | |
Topical antibiotics | Cretu et al. [37] | |
Topical antifungals | ||
Topical corticosteroids | ||
Low potency | ||
Mid potency | ||
High potency | ||
Topical calcineurin inhibitors | ||
Vitamin D analogs | ||
Coal tar | Andersen et al. [28] | Quan et al. [43] |
Topical doxepin | Albert et al. [14] | |
Combination therapies | ||
Topical antifungal and tar | Kapila et al. [18] | |
Low-potency TCS + topical antifungals | Albert et al. [14] | |
Low-potency TCS + TCIs | Kapila et al. [18] | |
Low-potency TCS + tar | Kapila et al. [18] | Kapila et al. [18] |
Low-potency TCS + topical vitamin D analog | Meeuwis et al. [17] | |
Low-potency TCS + tar + vitamin D analog | Fischer et al. [16] | |
Low-potency TCS + mid-potency TCS + tar | Kapila et al. [18] | Kapila et al. [18] |
Low-potency TCS + mid-potency TCS + tar + vitamin D analog | Kapila et al. [18] | |
Mid-potency TCS + tar | Kapila et al. [18] | Kapila et al. [18] |
Mid-potency TCS + tar + vitamin D analog | Kapila et al. [18] | |
High-potency TCS + vitamin D + tar | Kapila et al. [18] |
Treatments for Genital Psoriasis in Adults
Medication | Successful | Unsuccessful |
---|---|---|
Phototherapy | ||
UVB phototherapy | Kapila et al. [18] | |
PUVA | Albert et al. [14] | |
Immunosuppressants | ||
Mycophenolate mofetil | Guglielmetti et al. [23] | |
Methotrexate | ||
Biologics | ||
Adalimumab | Ješe et al. [24] | |
Ixekizumab | Ryan et al. [50] | |
Efalizumaba | Cassano et al. [26] | |
Oral antifungals | J Fam Pract 2016 [41] | |
Oral antibiotics | Quan et al. [43] | Singh et al. [22] |
Dapsone | ||
Doxepin | Albert et al. [14] | |
Antihistamines | Cretu et al. [37] | |
Antipsychotics | Shimamoto et al. [25] | |
Calcium gluconate | Cretu et al. [37] |
Treatment of Genital Psoriasis in the Pediatric Population
Sources | Study characteristics | Treatments and outcomes | ||||||
---|---|---|---|---|---|---|---|---|
Study design, level of evidence | Type of psoriasis | Site | Age | Cohort (M/F) | Successful | Unsuccessful | Result | |
Afsar et al. [6] | Case report, 5 | Napkin psoriasis | Diaper area | 5.5 months | 1 M | 0.05% clobetasone 17-butyrate cream daily, emollient cream | – | Overall regression with intermittent mild flares |
Amichai et al. [29] | Case report, 5 | Plaque psoriasis | Glans penis, distal parts of shaft | 10 years | 1 M | 1% pimecrolimus cream | Betamethasone 1% cream, calcipotriol ointment | Resolution of psoriatic lesions after 3 weeks of topical pimecrolimus, recurrence treated successfully |
Andersen et al. [28] | Open-label case series, 4 | Psoriasiform napkin dermatitis | Diaper area | 2.1 months (0–21) | 35 M/32 F | Tar (64), corticosteroid-vioform ointment (3) | Zinc paste, salicylic ointment, steroid ointment, or aniline dye solutions | Tar effective in 64 patients, corticosteroid-vioform ointment effective in 3 patients |
Baggio et al. [36] | Case report, 5 | Psoriasiform napkin dermatitis | Diaper area | 18 months | 1 F | Fluticasone propionate cream | Zinc oxide-based ointments, antifungal creams, desonide cream | Complete resolution at 1 week |
Creţu et al. [37] | Case report, 5 | Napkin psoriasis | Anogenital area, buttocks, upper 1/3 thighs | 4 months | 1 M | Systemic antihistamines, nonspecific desensitization treatment, rigorous hygiene, non-fluorinated topical corticosteroids | Antibiotic ointment for 5 days, calcium gluconate, topical corticosteroids | Significant improvement by day 2 of treatment |
Fergusson et al. [35] | Open-label case series, 4 | Psoriasiform napkin dermatitis | Diaper area | Infants | 22a | Zinc-oxide paste | Topical steroids | Complete clearance |
Fischer et al. [16] | Open-label case series, 4 | Plaque psoriasis | Vulva | 6 years (2–12) | 27 F | LPC and topical calcipotriol with 1% hydrocortisone (23) or methylprednisolone aceponate 0.1% ointment (4) | – | Symptom remission, LPC well tolerated |
Greco et al. [37] | Case report, 5 | Napkin psoriasis | Diaper area | 18 months | 1 F | – | Zinc oxide paste, nystatin, hydrocortisone acetate 2.5% ointment | Minimal improvement |
Hernandez et al. [45] | Case report, 5 | Vulvar psoriasis | Vulva, perianal area | 5 years | 1 F | Clobetasol 0.05% ointment twice daily | Triamcinolone 0.1% ointment twice daily | Significantly improved erythema on inner labial and perianal areas at 2 weeks, complete resolution at 4 weeks |
Kamer et al. [42] | Case report, 5 | Napkin psoriasis | Diaper area | 10 weeks | 1 F | Low-potency topical corticosteroids | – | Clearance of lesions at 2 weeks |
Rattet et al. [49] | Case report, 5 | Psoriasiform napkin dermatitis | Diaper area | 12 months | 1 F | Clomitrazole 1% cream, hydrocortisone 1% cream three times daily | – | Clearance of lesions at 2 weeks with mild erythema |
Rattet et al. [49] | Case report, 5 | Psoriasiform napkin dermatitis | Diaper area | 5 weeks | 1 M | Clomitrazole 1% cream, hydrocortisone 1% cream three times daily | – | Clearance of lesions at 4 weeks |
Watanabe et al. [38] | Case report, 5 | Pustular psoriasis | Diaper area | 4 months | 1 M | 0.2% ketoconazole cream daily | – | Complete clearance at 1 month |