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

Abstract

Psoriasis is a chronic immune-mediated inflammatory disease with significant medical and psychological comorbidities. In addition to having increased cardiovascular risk and mortality, psoriasis patients are more likely to be depressed, anxious, and endorse suicidal ideation than the general population. These patients often have low self-esteem and feel stigmatized due to their skin disease, which can prevent them from pursuing relationships, dating, and attending social activities. Up to 63% of adult psoriasis patients experience psoriatic lesions on their genital area during their lifetime, but often do not discuss these issues with their physicians due to embarrassment, stigmatization, or shyness about this sensitive location. However, psoriasis in sensitive areas, such as the genitals, may result in quality of life impairment greater than that of patients with psoriasis elsewhere on their body, particularly in respect to romantic relationships, intimacy, and sexual function. This article evaluates the current literature regarding the impact of genital psoriasis on the quality of life of affected patients.

Sex-related impairment and patient needs/benefits in anogenital psoriasis: Difficult-to-communicate topics and their impact on patient-centred care

“…They also reported more QoL impairments in general (DLQI) and in sexual functioning (DLQI-i9), as well as increased need to improve sex life (PNQ-i17). This general overview of results seems foreseeable and in accordance to previous literature [ 6 – 9 ], as genital psoriasis has been strongly associated with increased severity and with an increased number of previous systemic treatments (which can be considered a surrogate measure for severity over time) [ 30 ]. In addition, in-depth analyses considering patients’ gender and methodological constraints of PRO showed that the results were much more complex than the simple relationship between anogenital psoriasis and loss of QoL.…”

“…The present study was conducted to gain insight into the overall and sex-related QoL impairments, patient needs and treatment benefits in patients affected by anogenital psoriasis, compared to a control group of patients with psoriasis not affecting the anal or genital body regions. There is a remarkable lack of literature on disease burden in the presence of psoriasis lesions in the anal/genital skin, particularly studies relying on PRO [ 6 ]. This study has several strengths and provides innovative analyses and results, with relevant contributions for further research and clinical practice, namely: (1) the inclusion of both anal and genital psoriasis; (2) the use of a high-resolution grid scheme on the topology of psoriasis; (3) the analysis of overall and sex-related patient-defined needs and benefits from treatment in different groups in relation to gender and anogenital involvement; and (4) the examination of MR and NNR rates to sex-related items in widely used questionnaires.…”

“…However, generalised plaque-type or intertriginous psoriasis also affects the genital area in 29-40% of psoriasis cases [5]. A recent systematic review showed significant impairments in overall and in sexual quality of life (QoL), as well as increased feelings of stigmatisation and higher rates of depression among patients with genital psoriasis [6]. Qualitative studies have also described sexual dysfunction, decreased frequency of sexual activity, avoidance of sexual relationships and worsening of symptoms after sexual activity [7,8].…”

“…The impaired sexual experience was justified by both physical effects (e.g., cracking or pain) and psychosocial effects (e.g., embarrassment and feelings of stigmatisation). Other factors that have been associated with QoL and sexual health impairments are gender, with women presenting more QoL impairments than men [6,9], and younger age [9]. Early onset of psoriasis has been also associated with higher levels of internalised stigma, which is, in turn, a predictor of decreased QoL [10].…”

Mild therapeutic response of alopecia areata during treatment of psoriasis with secukinumab

“…Psoriasis is a chronic disease characterized by erythematous, scaly, and hyperkeratotic plaques that can extend all over the skin. Psoriasis is widely recognized to diminish quality of life, especially when sensitive areas, such as genitals, are involved [1]. Basic research and several clinical trials have suggested a dominant role of interleukin 17A (IL-17A) in the pathogenesis of psoriasis [2].…”