A conundrum of recurrent pustular lesions of the glans

Genital psoriasis rarely presents as isolated pustular lesions confined to the glans penis, often leading to misdiagnosis as sexually transmitted infections such as herpes genitalis. We report a 36-year-old male with recurrent pruritic lesions on the glans over four months, with seasonal exacerbations over the past three years, particularly in winter and summer. The patient, with no systemic comorbidities or extragenital lesions, was initially misdiagnosed and treated with antivirals without relief. Clinical examination revealed multiple erythematous papules with collarette of scale and pustules that ruptured to form non-scarring erosions. Histopathological examination confirmed pustular psoriasis. The patient responded completely to topical 2% tofacitinib within four weeks. Isolated genital pustular psoriasis is exceedingly rare, with limited cases reported in the literature. Diagnostic delay is common due to its overlap with other genital dermatoses and lack of typical psoriatic plaques. This case highlights the importance of considering non-venereal causes in persistent genital lesions and the role of histopathology in achieving accurate diagnosis.