gms | German Medical Science

Background: Plaque-type or intertriginous psoriasis affects the anogenital area in 29-40% of cases, resulting in significant disease burden, such as quality of life (QoL) impairments, high rates of depression and sexual impairment. However, anogenital psoriasis remain understudied because of embarrassment discussing these sensitive topics in clinical practice, and less is known about the specific needs of these patients.

Objective:

1.

To compare the disease burden (i.e., disease severity, intensity of symptoms, QoL impairments, anxiety and depression symptoms, sexual impairment) as well as patient needs and benefits, between patients with psoriasis with and without anogenital involvement.

2.

To test the associations between disease parameters and patient-reported outcomes (PROs).

Method: Preliminary data from the cross-sectional multicentre PsoGen study were analysed. German patients aged ≥18 years with plaque-type or intertriginous psoriasis completed self-report questionnaires on quality of life impairments, depression and anxiety, patient needs and benefits from treatments, and sexual impairment. Physicians assessed the severity of psoriasis (PASI) and the severity of anogenital involvement (sPGA-G).

Results: The sample included 81 patients with psoriasis (43.8±13.1 years, 56.8% male), 63 presented current lesions in the anal or genital area. Patients with anogenital psoriasis had higher severity of anogenital lesions (t=6.8, p<0.01). They also reported higher intensity of pain (t=2.7, p<0.01), pruritus (t=2.2, p=0.02) and burning sensations (t=2.4, p=0.03), more QoL impairments (t=2.7, p<0.01), depression symptoms (t=2.5, p=0.01), impairments in sexual activity because of psoriasis (t=2.6, p=0.01), and higher levels of sexual impairment (t=3.0, p<0.01). No significant differences were found for anxiety, frequency of sexual activity or treatment benefits. The needs of “be healed of all skin defects” and “get better skin quickly” were rated as more important by the patients with anogenital involvement. The regression analyses showed that current anogenital involvement, higher intensity of burning sensations, lower frequency and more limitations in sexual activity were the best predictors of PROs.

Discussion: Patients with anogenital psoriasis present higher disease burden, in general and related to their sexual activity. However, they do not report specific treatment goals related to sexual impairment; instead, they aimed at getting better skin quickly and be healed of all skin defects, perhaps hopping that the clearance of the anogenital skin would indirectly reduce psychosocial and sexual burden.

Practical implications: These results call for in-depth assessment of patient needs regarding treatments, as questionnaires might underrepresent indirect needs. In addition, the treatment focused only on the clearance of the anogenital skin (e.g., sPGA-G) might be insufficient to improve QoL and mental health; instead, comprehensive care should include psychosocial interventions targeting sex-related outcomes.

Appeal for practice: An open patient-physician communication about sensitive topics might be the best way of optimizing treatment for patients with anogenital psoriasis.