Psoriasis in the perianal area: clinical manifestations, differential diagnosis and therapy


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Abstract

Psoriasis is one of the most widespread dermatoses in the world with incidence about 2%. There are various clinical forms of psoriasis. One of the clinical varieties is inverse psoriasis, which is characterized by lesions of intertriginous areas, in particular the perianal area. Psoriasis in perianal area does not always have the clinical characteristics of typical plaque psoriasis. The scientific evidence accumulated to date suggests that patients with inverse psoriasis report a lower quality of life compared to patients with other psoriasis localizations. Localization of psoriasis in an area prone to maceration makes it difficult to carry out a differential diagnosis, which can lead to errors in the diagnosis, irrational treatment and increase the patient’s anxiety. The objective of this review is to systematize the available information on the clinical diagnosis and treatment of psoriasis in perianal area. The authors discuss in detail the features of the clinical manifestations of psoriasis in perianal area and the issues of differential diagnosis. Dermoscopy can be helpful in the diagnosis of psoriasis, especially in cases of unusual anatomical locations and/or manifestations. Therapies widely used in the treatment of plaque psoriasis in other areas of the skin may not always be suitable for the treatment of lesions in the intertriginous area, where the skin is significantly thinner, has more glands and is constantly exposed to pollution and friction. The best strategy in the treatment of psoriasis in perianal area may be to alternate topical calcineurin inhibitors or vitamin D analogs with short courses of topical glucocorticosteroids.

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About the authors

Aleksey A. Khryanin

Novosibirsk State Medical University; Regional Public Organization “Association of Obstetricians-Gynecologists and Dermatovenereologists"

Email: khryanin@mail.ru
Dr. Sci. (Med.), Professor at the Department of Dermatovenereology and Cosmetology; President Novosibirsk, Russia; Novosibirsk, Russia

A. V Sokolovskaya

Novosibirsk State Medical University

Novosibirsk, Russia

V. K Bocharova

Pavlov University

St. Petersburg, Russia

References

  1. Олисова О.Ю., Бакулев А.Л., Кохан М.М. и др. К вопросу о классификации псориаза. Вестник дерматологии и венерологии. 2021;97(5):18-25. doi: 10.1046/j.1365-2230.2001.00832.x
  2. Christophers E. Psoriasis - epidemiology and clinical spectrum. Clin Exp Dermatol. 2001;26:314-20. doi: 10.1046/j.1365- 2230.2001.00832.x.
  3. Myers W.A., Gottlieb A.B., Mease P. Psoriasis and psoriatic arthritis: clinical features and disease mechanisms. Clin. Dermatol. 2006;24:438-47. doi: 10.1016/j.clindermatol.2006.07.006.
  4. Raychaudhuri S.P., Farber E.M. The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol. 2001;15:16-7. doi: 10.1046/j.1468-3083.2001.00192.x.
  5. Клинические рекомендации: Псориаз. 2020. URL: https://www.cnikvi.ru/docs/clinic_recs/klinicheskie-rekomendatsii-2019-2020
  6. Omland S.H., Gniadecki R. Psoriasis inversa: a separate identity or a variant of psoriasis vulgaris? Clin Dermatol. 2015;33(4):456-61. doi: 10.1016/j.clindermatol.2015.04.007.
  7. Morris A., Rogers M, Fischer G., Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol. 2001;18:188-98. doi: 10.1046/j.1525-1470.2001.018003188.x.
  8. Afsar F.S., Uysal S.S., Salis F.M., Calli A.O. Napkin psoriasis. Pediatr Int. 2016;58:420-22. doi: 10.1111/ped.12916.
  9. Omland S.H., Gniadecki R. Psoriasis inversa: A separate identity or a variant of psoriasis vulgaris? Clin Dermatol. 2015;33:456-61.
  10. Fan X., Yang S., Sun L.D., et al.Comparison of clinical features of HLA-Cw*0602-positive and -negative psoriasis patients in a Han Chinese population. Acta Derm Venereol. 2007; 87:335-40.
  11. Wang G., Li C., Gao T., et al. Clinical analysis of 48 cases of inverse psoriasis: A hospital-based study. Eur J Dermatol. 2005;15:176-78.
  12. Dubertret L., Mrowietz U., Ranki A., et al. European patient perspectives on the impact of psoriasis: The EUROPSO patient membership survey. Br J Dermatol. 2006;155:729-36.
  13. Fouere S., Adjadj L., Pawin H. How patients experience psoriasis: Results from a European survey. J Eur Acad Dermatol Venereol. 2005;3(Suppl. 19):2-6.
  14. Ljubojevic H.S., Budinscak A., Zuzul K., et al. Coexistence of Anogenital Psoriasis and Genital Warts - Is There an Optimal Treatment? Acta Dermatovenerol Croat. 2019;27(4):270-2.
  15. Beck K.M., Yang E.J., Sanchez I.M., Liao W. Treatment of Genital Psoriasis: A Systematic Review. Dermatol Ther. (Heidelb). 2018;8(4):509-25. doi: 10.1007/s13555-018-0257-y.
  16. Zamirska A., Reich A., Berny-Moreno J., et al. Vulvar pruritus and burning sensation in women with psoriasis. Acta Derm Venereol. 2008;88:132-35. doi: 10.2340/000155550372.
  17. Meeuwis K.A., van de Kerkhof PC., Massuger L.F., et al. Patients' experience of psoriasis in the genital area. Dermatol. 2012;224:271-76. doi: 10.1159/000338858.
  18. Menter A., Korman N.J., Elmets C.A., et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad. Dermatol. 2011;65:137-74. doi: 10.1016/j.jaad.2010.11.055.
  19. Micali G., Verzi A.E., Giuffrida G., et al. Inverse Psoriasis: From Diagnosis to Current Treatment Options. Clin Cosmet Investig Dermatol. 2019;12:953-9. doi: 10.2147/CCID.S189000.
  20. ICD-11. Implementation or Trasition. URL: https://icd.who.int
  21. Хрянин А.А., Маркарьян Д.Р, Гарманова Т.Н., Бочарова В.К. Дерматозы перианальной области. Часть 2. Клиническая дерматология и венерология. 2021;20(4):117-26.
  22. Merola J.F., Qureshi A., Husni M.E. Underdiagnosed and undertreated psoriasis: nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther. 2018;31(3):e12589. doi: 10.1111/dth.2018.31.issue-3.
  23. Merola J.F., Li T., Li W., et al. Prevalence of psoriasis phenotypes among men and women in the USA. Clin Exp Dermatol. 2016;41:486-89.
  24. Dopytalska K., Sobolewski P., A., et al. Psoriasis in special localizations. Reumatol. 2018;56(6):392-98. doi: 10.5114/reum.2018.80718.
  25. Morar N., Willis-Owen S.A., Maurer T., Bunker C.B. HIV-associated psoriasis: pathogenesis, clinical features, and management. Lancet Infect Dis. 2010;10:470-78. doi: 10.1016/S1473-3099(10)70101-8.
  26. Yang E.J., Beck K.M., Sanchez I.M., et al. The impact of genital psoriasis on quality of life: a systematic review. Psorias. Auckl NZ. 2018;8:41-7. doi: 10.2147/PTT.S169389.
  27. Duarte G.V., Calmon H., Radel G., de Fatima Paim O.M. Psoriasis and sexual dysfunction: links, risks, and management challenges. Psorias. Auckl. NZ. 2018;8:93-9. doi: 10.2147/PTT.S159916.
  28. Dopytalska K., Sobolewski P., Bfaszczak A., et al. Psoriasis in special localizations. Reumatol. 2018;56(6):392-98. doi: 10.5114/reum.2018.80718.
  29. Cohen J.M., Halim K., Joyce C.J., et al. Shedding light on the «hidden psoriasis»: a pilot study of the Inverse Psoriasis Burden of Disease (IPBOD) questionnaire. J Drugs Dermatol. 2016;15(8):1011-16.
  30. Weisenseel P., Reich K. Psoriasis inversa. Hautarzt. 2015;6:408-12. doi: 10.1007/s00105-015-3628-7.
  31. Janniger C.K., Schwartz R.A., Szepietowski J.C., Reich A.Intertrigo and common secondary skin infections. Am Fam Physician. 2005;72(5): 833-8.
  32. Brandon A., Mufti A., Sibbald G.R. Diagnosis and management of cutaneous psoriasis: a review. Adv Skin Wound Care. 2019;32(2):58-69. doi: 10.1097/01.ASW.0000550592.08674.43.
  33. Wilmer E.N., Hatch R.L. Resistant «candidal intertrigo»: could inverse psoriasis be the true culprit? J Am Board Fam Med. 2013;26(2):211-14. doi: 10.3122/jabfm.2013.02.120210.
  34. Errichetti E., Lacarrubba F., Micali G., Stinco G. Dermoscopy of zoon's plasma cell balanitis. J Eur Acad Dermatol Venereol. 2016;30(12):e209-10. doi: 10.1111/jdv.13538.
  35. Errichetti E., Lallas A., Di Stefani A., et al. Accuracy of dermoscopy in distinguishing erythroplasia of queyrat from common forms of chronic balanitis: results from a multicentric observational study. J Eur Acad Dermato. Venereol. 2019;33(5):966-72. doi: 10.1111/jdv.2019.33.issue-5.
  36. Lacarrubba F., Ardigo M., Di Stefani A., et al. Dermatoscopy and reflectance confocal microscopy correlations in nonmelanocytic disorders. Dermatol Clin. 2018;36(4):487-501. doi: 10.1016/j.det.2018.05.015.
  37. Micali G., Verzi A.E., Lacarrubba F Alternative uses of dermoscopy in daily clinical practice: an update. J Am Acad Dermatol. 2018;79(6):1117-32.e1. doi: 10.1016/j.jaad.2018.06.021.
  38. Nasca M.R., Lacarrubba F., Caltabiano R., Micali G. Image gallery: reproduction of the auspitz sign by videodermatoscopy, confocal microscopy and horizontal histopathology. Br J Dermatol. 2019;180(6):e178. doi: 10.1111/bjd.2019.180.issue-6.
  39. Musumeci M.L., Lacarrubba F., Catalfo P., et al. Videodermatoscopy evaluation of the distinct vascular pattern of psoriasis improves diagnostic capability for inverse psoriasis. J Ital Dermatol Venereol. 2017;152(1):88-90. doi: 10.23736/S0392-0488.16.05212-3.
  40. Verzi A.E., Lacarrubba F., Caltabiano R., et al. Reflectance confocal microscopy features of plaque psoriasis overlap with horizontal histopathological sections: a case series. Am J Dermatopathol. 2019;41(5):355-57. doi: 10.1097/DAD.0000000000001297.
  41. Hong J.J., Mosca M.L., Hadeler E.K., et al. Genital and Inverse/Intertriginous Psoriasis: An Updated Review of Therapies and Recommendations for Practical Management. Dermatol Ther (Heidelb). 2021;11(3):833-44. doi: 10.1007/s13555-021-00536-6.
  42. Reynolds K.A., Pithadia D.J., Lee E.B., Wu J.J. Treatments for inverse psoriasis: a systematic review. J Dermatol Treat. 2020;31(8):786-93. doi: 10.1080/09546634.2019.1620912.
  43. Liao Y.H., Chiu H.C., Tseng Y.S., Tsai T.F. Comparison of cutaneous tolerance and efficacy of calcitriol 3 microg g(-1) ointment and tacrolimus 0.3 mg g(-1) ointment in chronic plaque psoriasis involving facial or genitofemoral areas: a doubleblind, randomized controlled trial. Br J Dermatol. 2007;157(5):1005-12. doi: 10.1111/j.1365-2133.2007.08201.x.
  44. Nazarian R., Weinberg J.M. AN-2728, a PDE4 inhibitor for the potential topical treatment of psoriasis and atopic dermatitis. Curr Opin Investig. Drugs Lond Engl. 2009;10(11):1236-42.
  45. Gold L.S., Bhatia N., Tallman A.M., Rubenstein D.S. A phase IIb, randomized clinical trial of tapinarof cream for the treatment of plaque psoriasis: secondary efficacy and patient-reported outcomes. J Am Acad Dermatol. 2020. doi: 10.1016/j.jaad.2020.04.181.
  46. Robbins K., Bissonnette R., Maeda-Chubachi T., et al. Phase 2, randomized dose-finding study of tapinarof (GSK2894512 cream) for the treatment of plaque psoriasis. J Am Acad Dermatol. 2019;80(3):714-21. doi: 10.1016/j.jaad.2018.10.037.
  47. Noji S., Hara Y., Miura T., et al. Discovery of a Janus kinase inhibitor bearing a highly three-dimensional Spiro scaffold: JTE-052 (delgocitinib) as a new dermatological agent to treat inflammatory skin disorders. J Med Chem. 2020;63(13):7163-85. doi: 10.1021/acs.jmedchem.0c00450.
  48. Ryan C., Menter A., Guenther L., et al. Efficacy and safety of ixekizumab in a randomized, double-blinded, placebo-controlled phase IIIb study of patients with moderate-to-severe genital psoriasis. Br J Dermatol. 2018;179(4):844-52. doi: 10.1111/bjd.16736.
  49. Guenther L., Bleakman P.A., Weisman J., et al. Ixekizumab results in persistent clinical improvement in moderate-to-severe genital psoriasis during a 52 week, randomized, placebo-controlled, phase 3 clinical trial. Acta Derm Venereol. 2020;100(1):adv00006. doi: 10.2340/00015555-3353.
  50. Guglielmetti A., Conlledo R., Bedoya J., et al. Inverse psoriasis involving genital skin folds: successful therapy with dapsone. Dermatol Ther (Heidelb). 2012;2(1):15. doi: 10.1007/s13555-012-0015-5.

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