Patients’ Perspectives on the Impact of Genital Psoriasis: A Qualitative Study

Abstract

IntroductionPlaque psoriasis is a chronic skin disease where genital involvement is relatively common. Yet health care providers do not routinely evaluate psoriasis patients for genital involvement and patients do not readily initiate discussion of it.MethodsA qualitative study of 20 US patients with dermatologist-confirmed genital psoriasis (GenPs) and self-reported moderate-to-severe GenPs at screening was conducted to identify key GenPs symptoms and their impacts on health-related quality of life (HRQoL).ResultsPatients had a mean age of 45 years, 55% were female, and patients had high rates of current/recent moderate-to-severe overall (65%) and genital (70%) psoriasis. Patients reported the following GenPs symptoms: genital itch (100%), discomfort (100%), redness (95%), stinging/burning (95%), pain (85%), and scaling (75%). Genital itching (40%) and stinging/burning (40%) were the most bothersome symptoms. Impacts on sexual health included impaired sexual experience during sexual activity (80%), worsening of symptoms after sexual activity (80%), decreased frequency of sexual activity (80%), avoidance of sexual relationships (75%), and reduced sexual desire (55%). Negative effects on sexual experience encompassed physical effects such as mechanical friction, cracking, and pain as well as psychosocial effects such as embarrassment and feeling stigmatized. Males reported a higher burden of symptoms and sexual impacts. Other HRQoL impacts were on mood/emotion (95%), physical activities (70%), daily activities (60%), and relationships with friends and family (45%). These impacts significantly affected daily activities. Physical activities were affected by symptoms and flares, and increased sweat and friction worsened symptoms. Patients reported daily practices to control outcomes.ConclusionThe high level of reported symptoms and sexual and nonsexual impacts reflects the potential burden of moderate-to-severe GenPs. GenPs can impact many facets of HRQoL and providers should evaluate their patients for the presence of genital psoriasis and its impact on their quality of life.FundingEli Lilly and Company.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-017-0204-3) contains supplementary material, which is available to authorized users.

Patients’ Perspectives and Experience of Psoriasis and Psoriatic Arthritis: A Systematic Review and Thematic Synthesis of Qualitative Studies

“…Learning to adjust to a chronic disease and accept a different lifestyle involved changing daily hygiene routines and choosing appropriate clothing. Some strived to "learn to live with it" (24) or "not let it get (them) down" (37).…”

Itch: an under‐recognized problem in psoriasis

“…Itch can affect the entire body, but it predominantly affects the legs, hands, back, body and scalp; the face is relatively spared . With genital involvement, itch and discomfort are common symptoms but may be under‐reported due to the patient's embarrassment . Whether the severity of psoriasis correlates with the intensity of itch is unclear, as patients have reported itch on both lesional and nonlesional psoriatic skin .…”

“…13,14,70 With genital involvement, itch and discomfort are common symptoms but may be under-reported due to the patient's embarrassment. 74,75 Whether the severity of psoriasis correlates with the intensity of itch is unclear, as patients have reported itch on both lesional and nonlesional psoriatic skin. 14,34 Itching can persist on a daily basis, throughout the day, or be worse only in the evening.…”

The impact of genital psoriasis on quality of life: a systematic review

“…These patients are less comfortable with their own nudity, dating, and intimacy compared with patients with psoriasis lesions on nonsensitive areas of their body 18. Patients experience pain during intercourse or worsening of symptoms after intercourse as well 25. Women in particular experience dyspareunia and are distressed by the impact of genital psoriasis on sexual function compared with men 7,28.…”