Genital Psoriasis — SCE Dermatology MCQ

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EasyGenital DermatologyGenital PsoriasisSCE Dermatology

A 45-year-old man has plaque psoriasis affecting his genitalia. He has well-defined erythematous patches on the glans penis and shaft without significant scale. What is the most appropriate first-line topical treatment?

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Correct answer: C — Mild-to-moderate topical corticosteroid or topical calcineurin inhibitor (Tacrolimus 0.1%)

Genital psoriasis requires modified topical treatment because genital skin is thinner and more susceptible to steroid side effects. Mild-to-moderate potency topical corticosteroids (Hydrocortisone 1%, Clobetasone butyrate 0.05%) or topical calcineurin inhibitors (Tacrolimus 0.1%) are first-line. Very potent steroids (Clobetasol), coal tar, and dithranol are too irritant for genital skin and should be avoided. Calcineurin inhibitors are particularly useful for genital psoriasis as they do not cause atrophy. The scale is typically absent or minimal in genital psoriasis due to the moist occluded environment. BASHH and BAD guidelines align on this approach.

Reference: BAD 2020 Psoriasis Guidelines; BASHH Genital Dermatoses