P85 Genital psoriasis in Asians: impact on quality of life and sexual health

Abstract Genital involvement and sexual dysfunction are common amongst patients with psoriasis; however, most patients do not discuss their genital rashes or sexual health with their doctor. The aim of this study was to evaluate the impact of genital psoriasis on quality of life (QoL) and sexual health in adult Asian psoriasis patients with genital psoriasis, an entity that is poorly understood, under-recognized and undertreated. We performed an observational study on adult Asian psoriasis patients attending psoriasis subspecialty clinics at a tertiary dermatology centre over 1 year. Participants underwent clinical examination of the whole-body surface, with particular attention to the genitalia, and questionnaires to evaluate QoL and psychosexual health were administered. Patients received a small renumeration for their participation. The study received no commercial funding. A total of 62 patients participated. Most participants were male (82.3%) and Chinese (59.7%) with a mean age of 41.7 years [standard deviation (SD) 12.5]. The commonest site involved was the suprapubis (61.3%). Perianal, glutaeal cleft and perineum involvement were more common amongst females (P < 0.05). The mean psoriasis area and severity index (PASI) score was 7.0 (SD 4.3) with a mean Dermatology Life Quality Index (DLQI) score of 9.8 (SD 6.7), indicating moderately impaired QoL. Higher PASI scores were associated with increasing QoL impairment on DLQI (P = 0.021). Males in whom genital psoriasis prevented sexual intercourse or diminished their libido reported more sexual dysfunction. Females reported greater severity in terms of symptomatic burden and feelings of embarrassment (P = 0.038) yet were less likely to be on treatment (37.5 vs. 45.0%). Perceived efficacy of treatment was low and younger patients fared poorer on the Patient Health Questionnaire-9 depression questionnaire (P = 0.047). Genital involvement may be a key contributor to the lower QoL compared with psoriasis patients without genital involvement. Although patients desire more efficacious treatment, they may be reluctant to discuss their genital rashes or sexual health when not prompted leading to under-recognition and under-treatment, particularly amongst female patients. More studies need to be performed with age and gender-matched control groups using validated QoL and sexual health questionnaires for genital psoriasis. Nonetheless, clinicians should proactively evaluate for and treat genital psoriasis, as disease control has been shown to restore both QoL and sexual function.