Jashin J. Wu (ed.)Clinical Cases in PsoriasisClinical Cases in Dermatology10.1007/978-3-319-52779-6_7

7. 16-Year-Old with Rash on Genitals

Mina Amin¹, Stacey Pun², Daniel No³ and Jashin J. Wu⁴

(1)

University of California, Riverside School of Medicine, Riverside, CA, USA

(2)

Keck School of Medicine of USC, Los Angeles, CA, USA

(3)

Loma Linda University School of Medicine, Loma Linda, CA, USA

(4)

Wu Medical Associates, Inc., Los Angeles, CA, USA

Jashin J. Wu

Email: jashinwu@gmail.com

Keywords

Genital psoriasisSensitiveLow-potency corticosteroidTacrolimusCalcitriol

A 16-year-old male presented to the clinic with a two-year history of an erythematous, pruritic rash on his penis and scrotum. Over-the-counter topical antifungal medication for self-presumed tinea cruris did not provide any benefit. Of note, the patient admits to developing secondary infections in the past due to perpetual scratching and poor care of affected sites. More recently, the patient has also developed red, scaly lesions on his neck, ears, and trunk. He denied joint pain, joint stiffness, and nail deformities. He is otherwise healthy, does not use medications, and has no known allergies. The patient has a family history of psoriasis.

On physical examination, there were bright, erythematous, well-defined plaques over the groin folds that extend to the dorsal penis, scrotum, and crease of buttocks. There was also some slight, fine scaling at the lateral edges in the pubic area. Examination of the remainder of the body revealed erythematous, well-defined, scaly plaques on the hairline at the nape of the neck, chest, abdomen, and postauricular skinfold.

Based on the clinical case description, what is the most likely diagnosis?

1.

Tinea cruris
2.

Fixed drug eruption
3.

Candidal intertrigo
4.

Genital psoriasis
5.

Erythrasma

Diagnosis

Genital psoriasis

Discussion

Genital psoriasis is a subtype of psoriasis that creates thin, bright, erythematous, well-defined plaques in the genital area. Genital psoriasis affects approximately one-third of patients with psoriasis (Ryan et al. 2015). The lesions produce minimal scaling; however, scales can appear in the keratinized areas of the genital region such as the penile shaft, scrotum, and near the labia majora. If scales are present, the Auspitz phenomenon also occurs upon removal of scales (Meeuwis et al. 2011). Genital psoriasis is associated with an early onset of disease and worse prognosis. It is more prevalent in males. The shaft of the penis is affected most, followed by the scrotum and glans penis. In females, genital psoriasis most commonly involves the labia majora, followed by the perineum and labia minora. Patients also frequently present with concomitant scalp, flexure, and nail involvement (Ryan et al. 2015).

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