Underdiagnosed and Undertreated Psoriasis: Nuances of Treating Psoriasis Affecting the Scalp, Face, Intertriginous Areas, Genitals, Hands, Feet, and Nails

Dermatol Ther. 2018 May;31(3):e12589. doi: 10.1111/dth.12589. Epub 2018 Mar 6.


Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.

Keywords: clinical studies; difficult to treat psoriasis; intertriginous; nails; palmoplantar; psoriasis; psoriasis of the extremities; quality of life; review; scalp; treatment options.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Facial Dermatoses / therapy
  • Female
  • Foot Dermatoses / therapy
  • Genital Diseases, Female / therapy
  • Genital Diseases, Male / therapy
  • Hand Dermatoses / therapy
  • Humans
  • Male
  • Nail Diseases / therapy
  • Psoriasis / diagnosis
  • Psoriasis / therapy*
  • Scalp Dermatoses / therapy