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Psoriasis — SCE Dermatology MCQ

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HardGenital DermatologyPsoriasisSCE Dermatology

A 30-year-old woman presents with persistent vulval itch. Examination shows well-defined erythematous glazed patches on the labia majora and interlabial sulci. Biopsy shows psoriasiform hyperplasia with neutrophilic microabscesses in the stratum corneum. There is no scale. What is the most likely diagnosis?

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Correct answer: B — Vulval psoriasis

Genital/flexural psoriasis often presents without the typical silvery scale seen at other body sites due to the moist environment. Instead, it shows well-defined erythematous glazed patches. The histological features of psoriasiform hyperplasia with neutrophilic microabscesses (Munro microabscesses) in the stratum corneum are characteristic of psoriasis. Vulval psoriasis can be misdiagnosed as candidiasis or dermatitis. Treatment is with low-to-moderate potency topical corticosteroids or topical calcineurin inhibitors (avoiding potent steroids on genital skin long-term).

Reference: BAD 2020 Psoriasis Guidelines; BSSVD 2019