engleski

DIAGNOSTIC AND THERAPEUTIC PITFALLS OF ANOGENITAL PSORIASIS

Anogenital psoriasis, also termed inverse/flexural/intertriginous psoriasis, due to the localization, is considered as a special site of involvement of plaque psoriasis. This entity affects about 2-5% of psoriatic patients. Anogenital region is perceived as a delicate localization so this form of psoriasis has a profound impact on the quality of life of patients because it is often misjudged as a sexually transmitted disease and highly influences emotional and sexual life. In order to establish the correct diagnosis, it is important to perform detailed patient’s examination (including obligatory total body examination, particularly intergluteal area, nails and scalp), as well as to attain detailed patient’s personal and family history. Lesions usually lack scale due to friction in the intertriginous area and fissurae can be present. Differential diagnosis of anogenital lesions varies regarding the patient’s age ; in children, the most common entities are infantile seborrheic dermatitis, candidiasis, diaper (napkin) dermatitis and also sometimes acrodermatitis entheropatica, while in adults we have to consider seborrheic dermatitis, contact allergic dermatitis, contact irritant dermatitis, dermatomycosis, lichen simplex chronicus, Bowen’s disease and squamocelullar carcinoma as most common differential diagnostic options. Also, clinical findings vary depending on the immunological status of the patient, e.g. immunosuppressed patients (HIV/AIDS, oncology patients etc.) have different clinical findings compared to immunocompetent patients. The diagnosis of anogenital psoriasis might be difficult and often requires a multidisciplinary approach ; bacterial and as well mycological cultures, histopathological analysis and HLA typization are often necessary. In terms of treatment, prolonged application of classical psoriatic therapy - topical corticosteroids is not recommended due to increased absorption of preparation in this region and also strong and persistent side effects such as epidermal atrophy ; the usage of salicylic acid, tars and cignolin in this area is not allowed. Although various successful therapeutic modalities are available such as topical immunomodulators, topical vitamin D analogues and biologics, this special entity still remains therapeutically demanding.

psoriasis, genital, therapy

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