Apremilast for Genital Psoriasis: 4 DISCREET Checks

The American Academy of Dermatology¹ advises telling your dermatologist about genital psoriasis even if you already have treatment for psoriasis elsewhere. Genital skin may need a different prescription plan. Do not transfer a cream from another body site without checking.¹

Who entered?

DISCREET randomized 289 adults, including 87 women, with moderate-to-severe genital psoriasis and plaque psoriasis elsewhere, inadequately controlled by or intolerant to topical therapy. They received apremilast 30 mg twice daily or placebo. Topical psoriasis medicines were prohibited.²

This is a treatment discussion after a diagnosis. If a genital patch has not been examined, start with that assessment rather than comparing oral medicines. Our vulvar psoriasis prescription guide helps organize questions about where each prescribed treatment belongs.

What counted as response?

Week-16 response meant genital skin clear/almost clear with at least two grades of improvement. Estimated rates were 39.6% (143 assigned) versus 19.5% (146 assigned); adjusted difference 20.1 percentage points, 95% CI 9.2–30.9. Missing assessments were multiply imputed.³

Tell the dermatologist what you want assessed alongside the skin examination: itching that interrupts sleep, pain when clothes rub or an activity you avoid. Ask which changes will be recorded at the next visit. The photograph or symptom note you bring should have a date so it can be compared with the treatment timeline.

What happened after week 16?

Placebo recipients switched to apremilast. Of 229 extension entrants, 201 completed 32 weeks. Later binary results counted missing responses as failures among entrants, not all 289 randomized patients. This was not another placebo comparison. Diarrhea affected 64/252 apremilast-treated patients across the study. Amgen funded it; authors disclosed employment/stockholdings.²

Before agreeing to continue, ask what will happen if the genital skin improves but itching still interrupts the day, or if another part of your psoriasis remains troublesome. Keep the review focused on the particular problems that prompted treatment.

What needs monitoring?

The September 2026 US label covers Otezla and Otezla XR for adults with plaque psoriasis who are candidates for phototherapy or systemic therapy. DISCREET tested immediate release. Ask which formulation is prescribed; severe kidney impairment requires different dosing, and XR is not recommended in that group.⁴

Contact the prescriber for severe diarrhea, nausea or vomiting; complications are more likely at 65 or older. Report new or worsening depression, suicidal thoughts or other mood changes. Monitor weight regularly. Stop treatment and seek medical help for a serious allergic reaction. Review interacting medicines, including strong enzyme inducers. Discuss pregnancy because animal findings indicate potential fetal loss, and discuss breastfeeding.⁴

Write down who to contact during the first weeks, when weight will be reviewed and what to do if stomach symptoms make it difficult to follow the prescription. Do not switch formulation or change the dose yourself.

Down There, Decoded includes “What to Say When You’re Embarrassed.” It suggests describing what changed and when, and typing a note on your phone if saying it aloud feels difficult. Use that preparation to bring the skin symptoms and treatment questions into the appointment.