Roflumilast Cream 0.3% for a Patient With Genital Psoriasis Refractory to Other Topical and Systemic Treatments: A...

Genital involvement is a frequent complication of plaque psoriasis (PsO) and is associated with substantial emotional and physical burden. We report a case of a male patient with genital PsO who did not respond to multiple systemic and topical therapies but achieved complete clearance with roflumilast cream 0.3% (a potent phosphodiesterase 4 inhibitor). After 28 weeks of initial treatment with guselkumab, body surface area (BSA) affected had fallen from 42 to 8 percent; however, new genital lesions were noted. After eight months of additional topical treatment, BSA affected had fallen to 2 percent, but the patient had developed gluteal cleft lesions as well. Over the next three years, several topical and systemic treatments were tried, but his genital and gluteal cleft disease persisted and intense pruritus developed. Based on concerns about continued topical corticosteroid use, the lack of efficacy observed thus far, and the potential for rebound flare, once-daily roflumilast cream 0.3% was initiated. At Week 8, BSA affected had fallen to 1 percent, and was limited to residual scalp disease (which had not been treated with roflumilast); the genitals and gluteal cleft were clear, with slight erythema present only on the scrotum. At 16 weeks, genital and gluteal cleft disease remained well-controlled with no evidence of active disease. Overall, roflumilast cream 0.3% was well tolerated with no pruritus, folliculitis, irritation, or contact dermatitis observed.