Considerations for Genital Psoriasis Care Across Age Groups: A Modified Delphi Consensus Initiative from the Genital Psoriasis Wellness Consortium

BACKGROUND: Genital psoriasis remains underdiagnosed and undertreated despite its substantial impact on quality of life. The sensitive nature of genital involvement contributes to diagnostic delays, patient distress, and treatment challenges. The Genital Psoriasis Wellness Consortium, a multidisciplinary panel of US-based clinicians, previously developed consensus statements on physical diagnosis, patient conversations, quality of life impacts, and treatment. OBJECTIVE: We aimed to build on prior work by providing additional considerations to refine best practices across three areas: physical exam and diagnosis; pediatric and adolescent treatment; and adult and geriatric treatment. METHODS: The panel used the modified Delphi process and nominal group technique, informed by a systematic literature review, with consensus defined as ≥ 75% agreement on a 7-point Likert scale. RESULTS: The panel emphasized routine genital assessment within comprehensive skin exams and proactive empathetic communication to reduce stigma, with verbal consent and the offer of a chaperone as standard practice. In pediatric care, shared decision making among clinicians, caregivers, and patients fosters adherence. In adults and older patients, treatment decisions should consider comorbidities, polypharmacy, and individual goals; prioritizing therapies with established safety in intertriginous areas and minimizing long-term corticosteroid use. Simple regimens and attention to access barriers were identified as important to support adherence. CONCLUSIONS: These considerations aim to enhance diagnosis, optimize treatment, and improve outcomes through personalized empathetic care.