Expert Consensus Offers Age-Specific Guidance for Genital Psoriasis Care

The Genital Psoriasis Wellness Consortium has published expert consensus offering age-specific guidance for genital psoriasis care, spanning physical examination, pediatric and adolescent treatment, and adult and geriatric treatment.

The recommendations, which are published in the American Journal of Clinical Dermatology, are part of a second-phase initiative developed by a 13-member US-based multidisciplinary panel.

Genital involvement occurs in more than 60% of patients with psoriasis over the disease course, yet it remains under-recognized and undertreated. No specific ICD-10-CM code exists for the condition, limiting data capture and obscuring its true burden. The panel built on the Consortium's earlier consensus work to address persistent gaps in diagnosis, communication, and age-appropriate management.¹

“Genital psoriasis is one of the most impactful, yet consistently overlooked, manifestations of psoriatic disease. Although it will affect the majority of individuals with psoriasis at some point in their lives, genital psoriasis remains vastly under diagnosed because clinicians aren't routinely asking and patients are hesitant to bring it up due to its sensitive nature,” said Michael J. Payette, MD, MBA, dermatologist at Central Connecticut Dermatology, associate clinical professor at UConn Health, Genital Psoriasis Consortium member, and manuscript lead author. “Our consensus work represents a 'call to action' and an important step forward, giving clinicians a comprehensive, age-specific roadmap to approach genital psoriasis with the same rigor they bring to every other aspect of dermatologic care. It has the potential to meaningfully direct the course of outcomes for individuals with genital psoriasis who have gone either undiagnosed or untreated for far too long.”

The panel applied a modified Delphi process with the nominal group technique, informed by a systematic PubMed literature review conducted in November 2024. Three subcommittees addressed physical exam and diagnosis, pediatric and adolescent treatment, and adult and geriatric treatment. Two rounds of anonymous online feedback refined each statement, with consensus defined as at least 75% agreement, using scores of 5 or higher on a 7-point Likert scale.¹

All statements reached consensus. The panel positioned routine genital assessment within comprehensive full-body skin examinations at both initial and follow-up visits. Verbal consent before the exam, ideally before the patient disrobes, was endorsed as a minimum standard, alongside the offer of a chaperone or third-party presence consistent with institutional and state requirements.

Panelists also recommended a structured differential framework organized by lesion morphology, lesion depth, and etiologic category. The approach aims to distinguish genital psoriasis from mimics such as lichen planus, candidiasis, and contact dermatitis, reducing misdiagnosis in a sensitive anatomical region.

Age-specific treatment guidance and corticosteroid stewardship

For pediatric and adolescent patients, the panel endorsed access to the full spectrum of therapies through shared decision making among clinicians, caregivers, and patients. Members favored simple regimens, gamified adherence tools, and in-office topical samples to support comfort and follow-through. When injectable agents are appropriate, the panel suggested selecting options with the fewest annual injections within a comparable class.

In adults and older adults, the panel advised basing treatment on comorbidities, polypharmacy, and individual goals rather than age alone. Skin fragility and higher irritation susceptibility in older patients warrant therapies with established safety in intertriginous areas.

Across every age group, panelists prioritized minimizing long-term topical corticosteroid use, citing risks of skin atrophy, striae, and systemic absorption with prolonged exposure. They highlighted advanced targeted topicals as alternatives to corticosteroids.

These include roflumilast (Zoryve), a topical phosphodiesterase-4 [PDE4] inhibitor, the only FDA-approved topical for psoriasis in intertriginous areas, and tapinarof (Vtama), an aryl hydrocarbon receptor [AhR] inhibitor, with pediatric tapinarof studies underway.¹ Access barriers such as insurance denials and prior authorization were flagged as threats to adherence.

To reduce stigma, the panel offered sample language for clinicians introducing a genital exam: “We know some patients may find this uncomfortable; a routine full skin exam includes the genitals.” The framing positions genital assessment as a normal component of comprehensive skin examination rather than an exception.

The work extends the Consortium's first-phase consensus, published in 2025 in the Journal of the European Academy of Dermatology and Venereology Clinical Practice.¹ Arcutis funded both initiatives.² The recommendations are positioned as a living framework, with revisions anticipated as genital-specific evidence accumulates.

References

1. Payette M, Bhutani T, Young M, et al. Considerations for genital psoriasis care across age groups: a modified Delphi consensus initiative from the Genital Psoriasis Wellness Consortium. Am J Clin Dermatol. Published online May 13, 2026. doi:10.1007/s40257-026-01035-0

2. Arcutis Biotherapeutics. New expert consensus provides age-specific guidance for improving genital psoriasis care. Published May 2026. Accessed June 3, 2026. https://investors.arcutis.com/news-releases/news-release-details/new-expert-consensus-provides-age-specific-guidance-improving