Sensitve area psoriasis

Surveys show that up to two-thirds of patients with psoriasis on other parts of their skin have genital psoriasis. Historically, it has tended to be a neglected and under-treated condition, even though it has a profound negative impact on quality of life, especially sexual function. It is not currently taken into account in any of the standard severity scores (e.g., PASI) used to assess psoriasis.

In this Australian study, researchers carried out a comprehensive review of the scientific literature on genital psoriasis. In all, 632 articles concerning genital psoriasis in adults were found in the period 1946-2022. Of these articles, 25 were original research studies that investigated various treatments for genital psoriasis among 877 patients. A further six studies explored quality of life measures in 2546 patients (61% male).

The key findings from this review are as follows:

• There is wide variation in the reported prevalence of genital psoriasis, ranging from 17% to 64%, and it tends to occur 6–10 years after the onset of psoriasis.
• The burden of genital psoriasis on an individual's quality of life is underappreciated, and whilst 80% of patients mentioned genital psoriasis to their doctor/dermatologist, these discussions are usually initiated by the patient.
• The impact on sexual activity appears to be more pronounced in women, not primarily due to reduced libido, but rather subjective sexual distress such as feelings of reduced physical attractiveness.
• Given that the peak onset of psoriasis lies between 15 and 30 years of age, when individuals are creating and maintaining sexual relationships, clinicians need to elicit and address sexual concerns.
• Current evidence supports initial treatment with topical steroids, though systemic treatments and biologics (specifically ixekizumab) are effective for more severe disease.

Comment:

This review clearly shows that genital psoriasis is seriously underappreciated and under-treated. Given the prevalence of genital psoriasis, clinicians involved in the management of psoriatic patients must themselves initiate discussion about genital involvement, especially in younger patients. Effective treatments are available, though much more research is needed to identify which regimen is the most efficacious. Most importantly, future studies need to take into account the under-representation of females in studies exploring quality of life and treatment options for genital psoriasis, especially since women have been shown to experience more sexual dysfunction compared to their male counterparts.

Reference:

Wu M, Fischer G. Adult genital psoriasis: An updated review for clinicians. Australas J Dermatol. 2024; 65:e1–e12. 

Author:
Dr David Ashton MD PhD.