Patients' Perspectives on the Impact of Genital Psoriasis: A Qualitative Study

Abstract

Introduction: Plaque psoriasis is a chronic skin disease where genital involvement is relatively common. Yet health care providers do not routinely evaluate psoriasis patients for genital involvement and patients do not readily initiate discussion of it.

Methods: A qualitative study of 20 US patients with dermatologist-confirmed genital psoriasis (GenPs) and self-reported moderate-to-severe GenPs at screening was conducted to identify key GenPs symptoms and their impacts on health-related quality of life (HRQoL).

Results: Patients had a mean age of 45 years, 55% were female, and patients had high rates of current/recent moderate-to-severe overall (65%) and genital (70%) psoriasis. Patients reported the following GenPs symptoms: genital itch (100%), discomfort (100%), redness (95%), stinging/burning (95%), pain (85%), and scaling (75%). Genital itching (40%) and stinging/burning (40%) were the most bothersome symptoms. Impacts on sexual health included impaired sexual experience during sexual activity (80%), worsening of symptoms after sexual activity (80%), decreased frequency of sexual activity (80%), avoidance of sexual relationships (75%), and reduced sexual desire (55%). Negative effects on sexual experience encompassed physical effects such as mechanical friction, cracking, and pain as well as psychosocial effects such as embarrassment and feeling stigmatized. Males reported a higher burden of symptoms and sexual impacts. Other HRQoL impacts were on mood/emotion (95%), physical activities (70%), daily activities (60%), and relationships with friends and family (45%). These impacts significantly affected daily activities. Physical activities were affected by symptoms and flares, and increased sweat and friction worsened symptoms. Patients reported daily practices to control outcomes.

Conclusion: The high level of reported symptoms and sexual and nonsexual impacts reflects the potential burden of moderate-to-severe GenPs. GenPs can impact many facets of HRQoL and providers should evaluate their patients for the presence of genital psoriasis and its impact on their quality of life.

Funding: Eli Lilly and Company.

Keywords: Burden of illness; Genital psoriasis; Health-related quality of life; Qualitative research.

Fig. 1

Frequency of patient reported genital psoriasis symptoms. Patients with current or recent (≤ 3 months) moderate-to-severe GenPs were asked an open-ended question (without any definition of symptoms) about the GenPs symptoms they experienced and were also questioned on predefined symptoms, whether spontaneously reported or not. Patients were asked which symptom(s) were the most bothersome (patients could report more than one symptom). a Frequency of symptoms. b Most bothersome symptom(s) for females (N = 11). c Most bothersome symptom(s) for males (N = 9)

Fig. 2

Frequency of patient-reported impacts from genital psoriasis. Patients with current or recent (≤ 3 months) moderate-to-severe GenPs were asked an open-ended question about the impact GenPs had on their lives and were also questioned on prespecified impacts, whether spontaneously reported or not. a Frequency of sexual impacts. b Frequency of nonsexual impacts. ^aPer interviewers’ judgment, the question was not asked of one patient due to auditory cues, conversation flow, and the patient’s apparent lack of comfort with sensitive topics. ^bPer interviewers’ judgment, the question was not asked of two patients due to auditory cues, conversation flow, and the patients’ apparent lack of comfort with sensitive topics