Genital psoriasis often goes under-reported and under-treated

Genital psoriasis often goes under-reported and under treated in primary care, the 2022 PCDSI Annual Meeting heard. 

HSE National Clinical Lead for Dermatology Prof Anne Marie Tobin, Consultant Dermatologist, Tallaght University Hospital, spoke about diagnosis and treatment of psoriasis in primary care, including more unusual sites. 

She said GPs should recognise that genital psoriasis “can have a significant impact on their [patients’] quality-of-life”. She also recommended that when a patient presents with scalp psoriasis, to “always remember to ask: ‘Do you have psoriasis anywhere else?’ And ‘do you have it in your groin?’”. 

It can be treated with “mild-mid” potency steroids, such as hydrocortisone or clobetasone (Eumovate), the latter of which she would start with. 

Prof Tobin also covered psoriasis of the scalp and the need to descale using an emollient before applying a potent topical steroid. 

She also spoke about palmo-plantar psoriasis, marked by thickening of the skin with erythema, which can cause fissuring. This should be treated with “thick, greasy emollients” to prevent cracking. Prof Tobin noted that palmo-plantar psoriasis “is difficult to treat with topical treatment and often patients will require treatments in secondary care”. 

Nail psoriasis causes lifting of the distal nail plate, and where nail psoriasis is aggressive, a fungal infection is “very common”, Prof Tobin added. Psoriasis at the nail site can be aided by keeping the nails clipped short and treated by a clobetasol propionate (Dermovate) or Betnovate scalp application overnight or Xamiol gel for two days a week for six months. 

Dr Tobin also highlighted the importance of informing patients that “psoriasis isn’t curable, but it can be controlled and we can control it so it has minimal impact on your life”. 

“All patients with psoriasis should use an emollient,” she added. “It reduces the scaling and the fissuring of the cracks. Because when the cracks fissure, they’re incredibly painful and itchy.” 

In a separate presentation at the meeting, Prof Tobin spoke about rashes involving the flexures and their treatment in primary care.