From the Guidelines
For inverse psoriasis in the genital area, alternatives to Protopic (tacrolimus) include low-potency topical corticosteroids such as hydrocortisone 1-2.5% or desonide 0.05%, which can be applied thinly 1-2 times daily for short periods (typically 1-2 weeks) 1. Non-steroidal options include pimecrolimus cream 1% (Elidel), which works similarly to tacrolimus but may be less irritating for some patients 1. Some key points to consider when treating inverse psoriasis in the genital area include:
- Calcitriol ointment or calcipotriene can also be effective and have fewer side effects than steroids 1
- For maintenance therapy, non-medicated emollients like petroleum jelly or zinc oxide preparations can help manage symptoms 1
- Coal tar preparations at low concentrations (1-2%) may help some patients but can be irritating in sensitive areas
- The genital skin is thin and highly absorptive, making it susceptible to steroid-related side effects like skin thinning and striae 1
- When using any treatment in the genital area, it's essential to apply sparingly and follow up with a healthcare provider if symptoms don't improve within 1-2 weeks or if irritation occurs Some benefits of these alternatives include:
- Reduced risk of steroid-related side effects
- Effective management of symptoms
- Improved quality of life for patients with inverse psoriasis in the genital area It's also important to note that patient education on the role of irritation and potential Koebnerization is an essential addition to the appropriate topical therapy 1.
From the Research
Alternatives to Protopic for Inverse Psoriasis of the Genital Tract
- Topical corticosteroids, which are commonly used as a first-line treatment for genital psoriasis and are well tolerated 2
- Vitamin D analogs, such as calcipotriene, which have been shown to be effective in improving genital and flexural psoriasis symptoms 3, 4
- Topical immunomodulators, which have been demonstrated to be effective in improving genital and flexural psoriasis symptoms 3, 5
- Antimicrobials, emollients, and tar-based products, which can be used as second and third-line therapies 5
- Systemic agents, such as anti-TNF and anti-IL12/IL23 therapy, which have been shown to be effective in inverse psoriasis resistant to topical therapy 5, 6
- Biologics, such as ixekizumab, which have been demonstrated to be effective in reducing genital psoriasis symptoms in a large, randomized, placebo-controlled trial 2
Considerations for Treatment
- The treatment of inverse psoriasis can be challenging due to the sensitivity and thinness of the skin in the genital area 4, 6
- Topical therapies, such as corticosteroids and vitamin D analogs, are often recommended as first-line treatments for genital and inverse psoriasis 4, 5
- Systemic therapies, such as IL-17 inhibitors and PDE-4 inhibitors, may be considered for patients with severe or resistant disease 4