Quality of life suffers in patients with genital psoriasis

Genital psoriasis is common, undertreated and takes a serious toll on quality of life, according to reviews and papers published since 2018.

During their lifetimes, as many as 63% of adults with psoriasis have psoriatic lesions on their genitals. Yet nearly 50% of those with genital psoriatic lesions don’t talk about the symptoms they’re experiencing with their physicians, suggesting genital psoriasis is undertreated, according to a review of the impact of genetical psoriasis on quality of life published online August 28, 2018 in Psoriasis (Auckland, N.Z.).¹

The problem with not addressing and treating genital psoriasis is the quality-of-life impairment from genital lesions may be greater than psoriasis elsewhere on the body.¹ Studies have shown that having psoriasis in general greatly impacts people’s sexual lives. Nearly three-quarters of people with psoriasis don’t feel comfortable dating, and 60% don’t want to pursue an intimate relationship because of it.¹

Sexual function impact of genital psoriasis
Genital involvement is a risk factor for sexual dysfunction among people with psoriasis, and sexual dysfunction occurs in up to 71.3% of all people with psoriasis. Other sexual dysfunction risk factors associated with psoriasis include disease severity and coexistence of depression or psoriatic rheumatism, according to a study published this year.²

Sexual dysfunction side effects might also result with psoriasis treatments, such as methotrexate and adalimumab (Humira, AbbVie).²

“Patients with genital psoriasis experience decreased frequency of intercourse, avoid sexual relationships and have reduced sexual desire,” report the authors of the review in Psoriasis (Auckl).¹

Genital psoriasis patients might be more likely than other psoriasis patients to have pain during and after intercourse.¹

Women with the condition, who often experience dyspareunia, appear to suffer more distress from genital psoriasis’s impact than men.¹

In a study of 150 Brazilian women with and without psoriasis, one in five women with psoriasis reported genital involvement. Psoriasis negatively impacted sexual function, including in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain.³

“Psoriasis is the most common inflammatory lesion of the male genitalia,” according to a paper in Sexual Medicine Review, published January 2019.⁴

But while having genital psoriasis impairs male sexual function, the presence of these lesions on male genital area is not linked to a significant increase in erectile dysfunction.¹

Genital psoriasis symptoms, presentation
Most, if not all, people with genital psoriasis suffer from itch, making it the most commonly reported symptom. Forty percent of genital psoriasis patients report itch is the most bothersome symptom; 40% report stinging and burning in the genital area is the most bothersome; and 20% report they’re most bothered by pain from genital psoriasis.¹ All of these symptoms can interfere with the quality of one’s sex life and intimacy.

Men with genital psoriasis most commonly present with the subtypes penile psoriasis and inverse psoriasis.⁴ Among the clinical signs: bright red, homogenous, sharply demarcated inguinal, scrotal or penile plaques without central clearing. Lesions are often pruritic, according to the paper in Sexual Medicine Review.⁴

What can you do?
About three-quarters of genital psoriasis patients believe that their physicians don’t pay enough attention to possible sexual problems from the condition.¹ And patients want dermatologists and other providers to do more to treat their symptoms.²

The vast majority of people with genital psoriasis go without treatment or are undertreated.¹ Up to 66% of these patients report they’ve never used treatment for their genital lesions.¹

These patients often don’t talk about the problem with their doctors because of the stigmatization, feeling shy or fear of judgement.

“Because of the taboo nature of genital skin disease and sexual impairment, physicians should take a proactive approach and ask their psoriasis patients and symptoms involving the genital area,” the review authors report.¹

Questions remain about the optimal treatment for genital psoriasis. Good hygiene and less than two weeks of a low-potency topical corticosteroid are today’s treatment mainstay.⁴

“Genital psoriasis is uniquely challenging to treat because of the sensitivity and high absorption of topical agents in the area…,” they write.¹

Researchers found sexual dysfunction in men with genital psoriasis improved with ixekizumab (Taltz, Eli Lilly) treatment.⁵

Dermatologists, according to the review, should look at what can be considerable quality-of-life deficits from genital psoriasis when considering systemic treatments - not just the degree of cutaneous involvement, they write.¹

More data needed
More studies using comparable quality-of-life instruments are needed to get a clearer picture of how genital psoriasis impacts quality of life, researchers report.¹

Having validated instruments for genital psoriasis (which didn’t exist but are in the works, according to the review in Psoriasis [Auckl]) will help researchers and ultimately dermatologists better understand how to best treat genital psoriasis.¹

References:

1 Yang EJ, Beck KM, Sanchez IM, Koo J, Liao W. The impact of genital psoriasis on quality of life: a systematic review. Psoriasis (Auckl). 2018;8:41-47.

2 Dauendorffer JN, Ly S, Beylot-barry M. Psoriasis and male sexuality. Ann Dermatol Venereol. 2019;146(4):273-278.

3 Kurizky PS, Martins GA, Carneiro JN, Gomes CM, Mota LMHD. Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis. An Bras Dermatol. 2018;93(6):801-806.

4 Gabrielson AT, Le TV, Fontenot C, Usta M, Hellstrom WJG. Male Genital Dermatology: A Primer for the Sexual Medicine Physician. Sex Med Rev. 2019;7(1):71-83.

5 Ryan C, Menter A, Guenther L, et al. Efficacy and safety of ixekizumab in a randomized, double-blinded, placebo-controlled phase IIIb study of patients with moderate-to-severe genital psoriasis. Br J Dermatol. 2018;179(4):844-852.