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Genital Psoriasis — SCE Dermatology MCQ

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ModerateGenital DermatologyGenital PsoriasisSCE Dermatology

A 30-year-old woman with plaque psoriasis has genital involvement that she finds embarrassing and functionally distressing. She rates her genital itch at 8/10 on a VAS. Her PASI is 5 and her genital DLQI impact is significant. What is the recommended approach?

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Correct answer: C — Recognise genital involvement as a high-impact site; treat with mild-moderate topical corticosteroid or TCI; escalate to systemic/biologic therapy if not controlled

Genital psoriasis affects approximately 30-60% of psoriasis patients but is significantly under-reported due to embarrassment. BAD guidelines recognise the genitalia as a high-impact site warranting proactive enquiry, specialist treatment, and systemic therapy escalation even with low PASI if genital disease significantly impacts quality of life. First-line genital treatment: mild-moderate topical corticosteroid (Hydrocortisone, Clobetasone butyrate) or topical calcineurin inhibitor (Tacrolimus 0.1% — preferred for maintenance as no atrophy risk). Very potent steroids should be avoided on genital skin. Soap substitutes and emollients are essential. Sexual health impact should be addressed sensitively.

Reference: BAD 2020 Psoriasis Guidelines; BSSVD