NEW YORK (Reuters Health) -- More than one-third of psoriasis patients have current genital involvement, which severely affects their quality of life and sexual health, according to new findings from two referral centers.
Psoriasis patients with genital involvement also had sex less often, and reported worse sexual function, than those whose genitals were not currently affected by the disease, Dr. Caitriona Ryan of Baylor University Medical Center in Dallas and her colleagues found.
"It has a very profound impact on their relationships and their sexuality," Dr. Ryan told Reuters Health.
Dermatologists need to be asking their patients with psoriasis about whether their genitals are affected, she added. "Unless a patient actually brings it up, a lot of dermatologists don't inquire about it," Dr. Ryan said. "It's something that should be done on a systematic basis."
The genitals are the most stigmatizing area for psoriasis involvement, no matter how severe a patient's disease, Dr. Ryan and her colleagues noted in their report, online March 30 in the Journal of the American Academy of Dermatology.
To investigate how genital involvement affected patients' quality of life and sexual functioning, the researchers looked at 354 consecutive adult psoriasis patients treated at Baylor and St. Vincent's University Hospital in Dublin, Ireland.
A total of 134 patients (38%) reported current genital involvement, while 63% reported either current or past involvement. For males, the most commonly affected areas were the penile shaft (36%), scrotum (33%), and glans penis (29%). Among affected women, 51% had involvement of the labia majora, 28% the perineum, and 23% the labia minora.
Eighty-seven percent of patients with genital involvement reported itching, while pain (39%) and dyspareunia (42%) were also common. A third of patients said their genital psoriasis got worse after they had intercourse, while 43% said they had intercourse less often due to genital involvement.
Patients with genital involvement scored significantly worse than those without genital involvement on the Dermatology Quality of Life Index, the Center for Epidemiological Studies-Depression Scale, and the Relationship and Sexuality Scale.
Men were more likely than women to have genital involvement, as were younger patients and those with an earlier onset of disease, the researchers found. Patients with more severe disease, as well as those who had used more systemic treatments in the past, were also more likely to have genital involvement. Flexural involvement and disease on the nails and scalp were also associated with a greater likelihood of genital involvement.
Psoriasis in the genital area is especially difficult to treat, Dr. Ryan noted, in part because higher-dose corticosteroids are contraindicated. It's also not clear, she added, how helpful systemic treatments are for genital psoriasis.
"It's an area that's really been neglected with regard to topical treatments and systemic treatments," she said. "These patients are distressed by their genital disease, and it's an area that really needs to be addressed."
SOURCE: http://bit.ly/1Ce8jZH
J Am Acad Dermatol 2015.