High prevalence of erectile dysfunction in men with psoriasis: evidence from a systematic review and meta-analysis

Female sexual dysfunction in psoriasis: a systematic review and meta-analysis using the Female Sexual Function Index

Psoriasis is an inflammatory skin condition that can negatively affect numerous domains for quality of life, including sexual function. We aimed to systematically compare sexual function between women with and without psoriasis through meta-analysis. Databases were searched for studies assessing sexual function in women with and without psoriasis using the Female Sexual Function Index (FSFI). Meta-analyses were conducted in R (v4.1.2) to determine: (i) the odds ratio (OR) of sexual dysfunction and (ii) the mean difference (MD) for FSFI scores and sub-scores. Eight studies (five case-control, three cross-sectional) were eligible for review, encompassing 563 women with psoriasis and 525 controls. Risk of bias for included studies was considered as low to moderate. Psoriasis was associated with greater odds of female sexual dysfunction (OR 2.67, 95% CI 1.93,3.69; p < 0.0001). Compared to controls, women with psoriasis had significantly lower mean scores for desire (p < 0.0001), arousal (p = 0.002), lubrication (p = 0.003), orgasm (p < 0.0001), satisfaction (p < 0.0001) and total scores (p < 0.0001). Mean pain scores did not significantly differ between psoriasis patients and controls (p = 0.051). We identified significantly impaired sexual function in women with psoriasis compared to controls, suggesting that routine assessment of sexual health may be beneficial. Prospective studies of larger sample size are required in order to explore the underlying mechanisms and risk factors.

Erectile dysfunction and metabolic syndrome components in obese men with psoriasis: response to a 12-week randomized controlled lifestyle modification program (exercise with diet restriction)

BACKGROUND

Erectile dysfunction (ED) and metabolic syndrome (MeTS) are highly prevalent in chronic plaque psoriasis (CPP).

OBJECTIVE

The aim of this lifestyle modification study is to explore the response of MeTS components and ED to a 12-week lifestyle modification program (low-calorie diet and moderate-intensity treadmill walking) in 60 obese men with CPP, mild and moderate ED, and MeTS.

THE DESIGN, SETTINGS, PARTICIPANTS, AND INTERVENTION

In this lifestyle modification randomized study, a university-based hospital recruitment of 60 obese men with CPP, mild and moderate ED, and MeTS was randomly performed. Men were randomly assigned to the lifestyle modification group (n = 30, received low-calorie diet and moderate-intensity treadmill walking programs) or waitlist group (n = 30). The following outcomes were assessed as follows: body mass index, psoriasis severity (assessed via psoriasis area and severity index), ED (assessed by the five-item internal index of erectile function), and components of MeTS (waist circumference, blood pressure, serum high-density lipoprotein, serum triglycerides, and serum fasting blood glucose).

RESULTS

Trends of significant improvements in all outcomes were documented in favor of the lifestyle modification group. All outcomes of the waitlist group did not show the same reported significant improvements of the lifestyle modification group.

CONCLUSION

A 12-week lifestyle modification program as a tool for weight loss in obese men with CPP is a good therapeutic method to improve psoriasis severity and psoriasis-associated ED and MeTS.

Sexual functioning in patients with psoriasis: the role of body dissatisfaction and cognitive biases toward sexuality

Psoriasis is a chronic disease, involving skin and joints, characterized by inflamed lesions. Psoriasis negatively impacts the patients' quality of life due to the physical, emotional, and social burden that accompanies this condition. Also, psoriasis is associated with a number of psychiatric comorbidities, including sexual dysfunctions. The present study investigates the variables associated with sexual functioning in psoriasis patients. One-hundred-three psoriasis patients and 101 matched control subjects took part in the present study. Each participant completed five self-report measures investigating the presence of depression, anxiety and stress symptoms, body image, quality of life, and sexual experience. Our results show that differences in sexual activity, but not in sexual functioning, emerged between groups. In men with psoriasis, more sexual difficulties were associated with more negative automatic thoughts about sexuality. In women, more sexual difficulties were associated with more negative automatic thoughts; anxiety, depression, and stress; severity of symptoms; comorbid disease; age; quality of life. Our findings expand the current knowledge about sexual functioning in psoriasis and shed light on specific cognitive, psychological, and demographic variables associated with sexual impairment in men and women with psoriasis.

Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

Psoriasis is a chronic autoimmune inflammatory disease that remains active for a long period, even for life in most patients. The impact of psoriasis on health is not only limited to the skin, but also influences multiple systems of the body, even mental health. With the increasing of literature on the association between psoriasis and extracutaneous systems, a better understanding of psoriasis as an autoimmune disease with systemic inflammation is created. Except for cardiometabolic diseases, gastrointestinal diseases, chronic kidney diseases, malignancy, and infections that have received much attention, the association between psoriasis and more systemic diseases, including the skin system, reproductive system, and oral and ocular systems has also been revealed, and mental health diseases draw more attention not just because of the negative mental and mood influence caused by skin lesions, but a common immune-inflammatory mechanism identified of the two systemic diseases. This review summarizes the epidemiological evidence supporting the association between psoriasis and important and/or newly reported systemic diseases in the past 5 years, and may help to comprehensively recognize the comorbidity burden related to psoriasis, further to improve the management of people with psoriasis.

Sexual Dysfunction and Atopic Dermatitis: A Systematic Review

Atopic dermatitis (AD) is a chronic inflammatory disease of the skin whose main symptom is pruritus and may affect all age ranges. Regarding the prevalence, it has been estimated at around 10% of the world population. Many concomitant diseases have been associated with AD, but the causal relationship between AD and psychological impairment has not been clearly established. Scientific literature studying the probable association between male or female sexual dysfunction and dermatological pathology is limited, even more so in AD. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines and the Cochrane Collaboration methodology for systematic reviews. All relevant articles in English were identified through a search from inception to 10 December 2020, including the following databases: Medline (via PubMed), Scopus, Web of Science Core Collection, and SciELO. The results of the search were compiled using the COVIDENCE software for systematic reviews. The methodological quality of the included studies was done using the “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies” and the “Quality Assessment of Case-Control Studies” developed by the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH). Our search yielded potentially relevant studies. Five studies that evaluated the prevalence of sexual dysfunction in atopic dermatitis were retrieved after applying the selection criteria. The present systematic review achieved data from 8088 patients with atopic dermatitis from four articles. Sample sizes for atopic dermatitis patients ranged from 266 to 3997. We identified one cohort study with four years of follow-up, three studies with a cross-sectional design, and one case-control study. Three studies reported data disaggregated by the severity of atopic dermatitis. Two studies included healthy controls with a total sample size of 1,747,755 subjects. Two studies compared data with other dermatological conditions such as psoriasis. In conclusion, we can establish that unlike other psychological comorbidities such as anxiety and depression, sexual dysfunction is a field scarcely explored in the literature. This sexual dysfunction focuses on the male sex in large population studies and in clinical diagnoses without exploring it through specific and validated questionnaires in this regard. Further studies focused on both genders are needed. It is important to correlate this sexual dysfunction with the severity of the disease, previous treatments, and cardiovascular comorbidities.

Beta-catenin non-canonical pathway: A potential target for inflammatory and hyperproliferative state via expression of transglutaminase 2 in psoriatic skin keratinocyte

Psoriasis is a chronic, local as well as a systemic, inflammatory skin condition. Psoriasis influences the quality of life up to 3.8% of the population and occurs often between 15 and 30 years of age. Specific causes are linked to psoriasis, including the interleukin IL-23/IL-17 Axis, human antigen leucocyte (HLA), and tumor necrosis factor-α (TNF-α). Secukinumab is a monoclonal antibody that specifically binds and neutralizes IL-17A required in the treatment of Psoriasis. The signaling pathways of Wnt govern multiple functions of cell-like fate specification, proliferation, polarity, migration, differentiation with their signaling controlled rigorously, given that dysregulation caused by various stimuli, can lead to alterations in cell proliferation, apoptosis, and human inflammatory disease. Current data has supported non-canonical Wnt signaling pathways in psoriasis development, particularly Wnt5a activated signaling cascades. These interconnected factors are significant in interactions between immune cells, keratinocytes, and inflammatory factors due to a higher degree of transglutaminase 2, mediated by activation of the keratinocyte hyperproliferation of the psoriatic patient's epidermis. This study discusses the pathology of Wnt5a signaling and its involvement in the epidermal inflammatory effects of psoriasis with other related pathways.

Genital Psoriasis: Impact on Quality of Life and Treatment Options

Psoriasis involving the genital skin occurs in up to two-thirds of psoriasis patients but is often overlooked by physicians. Furthermore, psoriasis objective and subjective severity indexes for common plaque psoriasis often neglect the impact this small area of psoriasis can have on a patient. It can have a significant impact on patients' psychosocial function due to intrusive physical symptoms such as genital itch and pain, and a detrimental impact on sexual health and impaired relationships. The mainstay of treatment is topical therapy. In patients with genital psoriasis refractory to traditional topical treatment, biologic treatments may greatly improve patient outcomes.