People with psoriasis have an increased risk for sexual dysfunction (SD) and erectile dysfunction (ED), according to the results of a systematic review of epidemiologic studies. Findings from the review were published in JAMA Dermatology.
The investigators of this analysis sought to explore the available scientific evidence on the epidemiologic associations and treatment outcomes between the presence of psoriasis and SD and ED. The literature search for the relevant terms psoriasis and sexual or sexual dysfunction was conducted on August 25, 2017. The search was restricted to only epidemiologic studies published in English, ultimately yielding a total of 28 studies, representing 52,520 cases of psoriasis and 1,806,022 controls for review. Quality was evaluated based on the Centre for Evidence-Based Medicine guidelines.
Of the 28 studies, 19 were cross-sectional, 3 were quasi-experimental, 3 were clinical trials, 2 were population-based, and 1 was a population-based case-control study. The prevalence of ED and SD ranged from 34.2% to 81.1% and 40.0% to 55.6%, respectively. In 2 of 2 studies, an association was observed between psoriasis and SD after adjusting for physical and psychological comorbidities. In 5 of 8 studies, an independent association was shown between ED and psoriasis.
In individuals with psoriasis, the features that demonstrated the strongest relationship with SD were anxiety and depression (5 of 5 studies), genital psoriasis (5 of 7 studies), and psoriatic arthritis (3 of 4 studies). With respect to ED, the features with the strongest association were increasing age (3 of 3 studies), and anxiety and depression (2 of 2 studies). All 3 clinical trials in which biologic agents were used reported an improvement in SD compared with placebo treatment.
The researchers concluded that individuals with psoriasis have physical and psychological comorbidities that have been linked to a higher risk for SD. Moreover, psoriasis-associated inflammation may contribute to the development of SD. The presence of depression, anxiety, genital lesions, increasing age, and psoriatic arthritis in a person with psoriasis should raise the awareness of possible sexual problems.
Molina-Leyva A, Salvador-Rodriguez L, Martinez-Lopez A, Ruiz-Carrascosa JC, Arias-Santiago S. Association between psoriasis and sexual and erectile dysfunction in epidemiologic studies: a systemic review [published online October 10, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.3442