Sex and the skin: A qualitative study of patients with acne, psoriasis and atopic eczema

Prevalence, Predictors, and Longitudinal Course of Sexual Dysfunction in Adults With Atopic Dermatitis

BACKGROUND

Little is known about the burden of sexual dysfunction (SD) in atopic dermatitis (AD).

OBJECTIVE

The objective of this study is to determine the prevalence and associations of SD in adults with AD.

METHODS

A prospective dermatology practice-based study of adult patients (N = 677) with AD was performed. Sexual dysfunction in the past 7 days was assessed by patient report (4-point Likert scale). Atopic dermatitis severity was assessed using multiple validated clinician-reported and patient-reported outcomes.

RESULTS

At baseline, SD was reported by 19.35% of patients and was associated with being married (adjusted odds ratio [95% confidence interval], 2.252 [1.226-4.136]) and younger age (3.363 [1.768-6.397]) but not race or gender in models controlling for sociodemographics and AD severity. Adult-onset versus childhood-onset AD (2.781 [1.211-6.383]) was associated with significant SD. Sexual dysfunction and SD severity were associated with total and objective scoring AD, Eczema Area and Severity Index, body surface area, Investigator's Global Assessment, and their cross-product, Patient-Oriented Eczema Measure and Patient Global Assessment of AD. Atopic dermatitis lesions on the genitals (3.255 [1.405-7.541]), neck (2.244 [1.066-4.723]), and lower extremities (2.236 [1.265-3.951]) were particularly associated with SD.

CONCLUSIONS

Sexual dysfunction is commonly reported by adults with AD and is associated with marriage, adult-onset AD, AD severity, and lesions on the genitals.

Psychosocial health and psychological adjustment in adolescents and young adults with congenital melanocytic nevi: Analysis of self-reports

This study assessed self-reported health-related quality of life and psychological adjustment in 43 adolescents and young adults (ages in years: 14–24, M = 17.6, SD = 2.2) with congenital melanocytic nevi (CMN) and examined associations with sociodemographic variables, characteristics of the CMN, perceived social reactions, and cognitive emotion regulation strategies. Outcome measures included the Pediatric Quality of Life Inventory^™ 4.0 and the Strengths and Difficulties Questionnaire. Findings suggest impaired psychosocial health and psychological adjustment in youth with CMN compared to community norms. Impairments were associated with higher age of participants, lower socioeconomic status, visibility of the skin lesion, perceived stigmatization, poorer perceived social support, and maladaptive cognitive emotion regulation strategies (self-blame, rumination, and catastrophizing), but not with sex of participants, extent of the skin lesion, and surgical removal of the nevus. Implications for clinical practice and future research are discussed.

Sexual Self-Esteem and Psychological Burden of Adults With Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is one of the most common tumor predisposition syndromes which primarily affects the skin. NF1 is characterized by various degrees of skin tumors and pigmentation abnormalities such as café-au-lait macules. Other skin diseases, such as psoriasis or neurodermatitis, have a negative influence on sexuality and quality of life and represent a psychological burden for those affected. The present study investigated the extent to which skin tumors (disfigurement) are related to sexuality and psychosocial factors in NF1 individuals. An anonymous online survey was carried out on Facebook and the webpage of the German Neurofibromatosis Association and a total of 166 persons participated. Of these participants, 92 were affected by NF1.74 healthy persons took part in the survey as a comparative group. Results show a significant relation between sexuality, body image, quality of life and the presence of depressive symptoms of the NF1 affected persons. Individuals with NF1 show a more negative sexual self-esteem. These concerns should be taken into account in NF1- related health care approaches.

"Worse Than Disappointing": Prediagnostic Health Care Challenges of Women With Inflammatory Vulvar Dermatoses

OBJECTIVE

The purpose of this study was to investigate challenges women face before inflammatory vulvar dermatosis diagnosis to guide interventions for improving time to diagnosis and health care experiences.

MATERIALS AND METHODS

The present analysis was part of a larger study exploring sexual health and quality of life of women with vulvar and nonvulvar inflammatory dermatoses, evaluated via a 20-minute web-based survey. One open-response item asked participants to "briefly describe any challenges you faced with regards to health care or health care providers in the time when you were seeking a diagnosis"; this item informed the present study. Eligible participants were women older than 18 years, living in the United States, with diagnosis of an inflammatory vulvar dermatosis persisting at least 1 month. Participants (n = 118) had a mean age of 46.55 ± 15.35 years, and 64% (n = 75) had lichen sclerosus.

RESULTS

Provider-based challenges consisted of insensitive communication and ascribing physical symptoms to mental health issues, self-harm, or other factors. System-based challenges included confusing referral networks, limited specialist access, and widespread lack of provider education. Personal challenges for participants seeking care included feelings of embarrassment and reduced health care efficacy. Challenges led to emotional response and impact for participants, characterized by negative (e.g., distrust in the medical system) or positive (e.g., self-advocacy efforts, strong social media communities) outcomes.

CONCLUSIONS

Findings provide unique insights into the challenges women experience before inflammatory vulvar dermatosis diagnosis. This study creates new knowledge exploring the diagnostic journey accompanying inflammatory vulvar dermatoses and contributes practically to clinical and research needs of this understudied population.

Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research

OBJECTIVES

The objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs).

DESIGN

Systematic review and synthesis of qualitative papers.

METHODS

Papers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings.

RESULTS

A total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people's experience of acne and HCPs' attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was 'trivialised' by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others.

CONCLUSIONS

People need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use.

PROSPERO REGISTRATION NUMBER

CRD42016050525.

Dermatological diseases, sexuality and intimate relationships: A qualitative meta-synthesis

AIMS AND OBJECTIVES

To conduct a systematic review and meta-synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases.

BACKGROUND

Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self-esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue.

DESIGN

A systematic review and meta-synthesis of qualitative studies.

METHODS

BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June-November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta-synthesis to identify overarching themes.

RESULTS

Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies.

CONCLUSION

When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included.

RELEVANCE TO CLINICAL PRACTICE

An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality-related issues patients face.

Conceptual Model to Illustrate the Symptom Experience and Humanistic Burden Associated With Atopic Dermatitis in Adults and Adolescents

Supplemental digital content is available in the text.

Atopic dermatitis (AD) is a pruritic or painful dermatologic disease characterized by xerosis and eczema lesions. The symptoms/signs of AD can significantly impact patients' health-related quality of life (HRQoL). This study aimed to qualitatively explore the adult and adolescent experience of AD. A targeted literature review and qualitative concept elicitation interviews with clinicians (n = 5), adult AD patients (n = 28), and adolescent AD patients (n = 20) were conducted to elicit AD signs/symptoms and HRQoL impacts experienced. Verbatim transcripts were analyzed using thematic analysis. Twenty-nine symptoms/signs of AD were reported, including pruritus, pain, erythema, and xerosis. Atopic dermatitis symptoms/signs were reported to substantially impact HRQoL. Scratching was reported to influence the experience of symptoms and HRQoL impacts. Four proximal impacts (including discomfort and sleep disturbance) were reported. Ten domains of distal impact were reported, including impacts on psychological and social functioning and activities of daily living. A conceptual model was developed to summarize these findings. This study highlights the range of symptoms and HRQoL impacts experienced by adults and adolescents with AD. To our knowledge, this study was first to explore the lived experience of AD in both adult and adolescent patients, providing valuable insight into the relatively unexplored adolescent experience of AD.

Young people's perceptions of acne and acne treatments: secondary analysis of qualitative interview data

Background

Acne vulgaris is a common skin condition affecting approximately 95% of adolescents to some extent. First‐line treatments are topical preparations but nonadherence is common. A substantial proportion of patients take long courses of oral antibiotics, associated with antibiotic resistance.

Objectives

This study aimed to explore young people's views and experiences of acne and its treatments.

Methods

We report a secondary thematic analysis of interview data collected by researchers in the Health Experiences Research Group (HERG), University of Oxford. A total of 25 transcripts from young people aged 13–24 years with acne were included.

Results

Acne is often perceived as a short‐term self‐limiting condition of adolescence and this appears to have implications for seeking treatment or advice. Participants widely perceived topical treatments as being ineffective, which seemed related to unrealistic expectations around speed of onset of action. Many participants felt they had tried all available topical treatments, although were unsure what was in them or unaware of differences between cosmetic and pharmaceutical treatments. They had concerns around how to use topicals ‘properly’ and how to avoid side‐effects. They were also concerned about the side‐effects or necessity of oral treatments, although few seemed aware of antibiotic resistance.

Conclusions

People with acne need support to manage their condition effectively, particularly a better understanding of different topicals, how to use them and how to avoid side‐effects. Unrealistic expectations about the onset of action of treatments appears to be a common cause of frustration and nonadherence. Directing people towards accessible evidence‐based information is crucial.

What's already known about this topic?

There is a common perception that acne is a short‐term condition that will resolve without treatment.

Previous research has shown that nonadherence to topical treatments is common and that oral antibiotics are the most commonly prescribed treatment for acne in the U.K.

Further research is needed to understand how young people perceive acne treatments and the implications of this for treatment adherence and self‐management.

What does this study add?

People often said they had tried all available topical preparations for acne, but seemed confused between cosmetic and pharmaceutical treatments.

People seemed unsure how to use topical treatments ‘properly’ or how to avoid side‐effects. This was rarely discussed with health professionals.

People's perception of acne as a short‐term condition appeared to influence their expectations around onset of action of treatment and their views about its effectiveness and necessity.

What are the clinical implications of the work?

The perception of acne as a short‐term condition has implications for self‐management and motivation to seek and adhere to treatments.

Providing advice about onset of action of treatments and how to prevent side‐effects is crucial, including directing people towards accessible, written, evidence‐based information.

People's confusion about the different topical treatments available may be alleviated by such information, or by encouraging photos or other recordings of treatments tried and for how long.

Linked Comment: Prior. Br J Dermatol 2020; 183:208–209.

Linked Comment: Prior. Br J Dermatol 2020; 183:208–209.

Plain language summary available online

Sexual satisfaction and self-esteem in women with acne

BACKGROUND

A significant number of problems related to mental and social functioning is a common occurrence in patients with acne.

AIMS

The aim of our study was to determine how acne affects self-esteem and sexual satisfaction in the affected women.

PATIENTS/METHODS

The study was conducted among 90 women, aged 18-51 years (mean 30.29 ± 7.10), diagnosed with acne. Demographic data, medical history and information concerning their sexual life were obtained from all study participants. After dermatological assessment of lesion location and severity, all subjects completed the following questionnaires: Rosenberg Self-Esteem Scale, Sexual Self-Esteem Inventory, Body Attitudes Questionnaire, and Whitley Sexual Satisfaction Inventory.

RESULTS

Two factors-lesion severity and self-assessment of the body-proved to shape the sexual satisfaction of women, but the influence turned out to be mediated through self-esteem.

CONCLUSION

Acne proves to play an important negative role in female sexuality and satisfaction.

Sexual quality of life in female patients with acne

Acne is a common skin disease which can have a negative psychosocial impact on quality of life. Sexual health is an important part of overall health and little is known about the effects of acne on individual sexuality. We aimed to assess the sexual quality of life and general quality of life in female patients with acne and compare to those without acne. Sixty female participants with acne and age-matched 40 female controls were enrolled in the study and asked to complete the Sexual Quality of Life-Female Questionnaire and the Short Form-36 Health Survey. Acne severity was evaluated objectively by the Global Acne Grading System and subjectively by the Visual Analogue Scale. Participants reported a significantly worse sexual quality of life and had significantly decreased scores on the quality of life scales of Bodily Pain, General Perception of Health and the Physical Component Summary when compared to controls. Neither the sexual quality of life nor the quality of life was correlated with objective and subjective acne severity and duration of acne. Acne can negatively affect sexual quality of life in female patients as well as differentdimensions of quality of life. The sexual quality of life should be considered while evaluating acne in women irrespective of its severity.

Understandings and experiences of visible difference and romantic relationships: A qualitative exploration

The association between disfigurement ('visible difference') and romantic relationships has received relatively little consideration in the research literature. This qualitative research, conducted in the United Kingdom, explored participants' accounts of their visible difference and romantic life. Semi-structured interviews were conducted with 22 participants who had a variety of visible differences. Inductive thematic analysis demonstrated that participants understood their difference as having a pervasive and enduring impact. These encompassed challenges that must be negotiated in the formation of romantic relationships, including feeling unattractive to others and feeling personally devalued. Relevant physical and sexual sequelae were comprised of anxieties regarding informing partners of a difference, impacted sexual activity, and concerns about heritability. Finally, the potential for partner support and acceptance to positively impact romantic relationships was recognised. This research highlighted the need to extend our understanding of visible difference and intimate relationships and to develop effective interventions to ameliorate appearance-related concern.

Preliminary development of a questionnaire assessing the impact of psoriasis and psoriatic arthritis on patient's perception of sexuality

Psoriasis and psoriatic arthritis impact sexuality and intimate relationships in both men and women, and can be associated with sexual dysfunctions.The aim of this study was to develop and validate a specific questionnaire assessing the impact of psoriasis and psoriatic arthritis on patients' sexuality. Two focus groups of patients, concerned by sexuality, were conducted in February 2015. Based on the verbatim transcripts, a content analysis was performed by a psychologist trained in qualitative procedures.After analysis of the verbatim reports by the research group, a preliminary questionnaire comprising 22 questions was drawn up. The areas covered by the questions concerned: the quality of daily life, tolerance of the cutaneous state by the patient, tiredness, mobility and flexibility of the joints, outside activities involving movement of all or part of the body. In the following step the questions were then submitted to a panel of experts for selection using a Delphi method. The experts were questioned about item relevance and content. After expert consensus had been reached, the instructions to participants completing the questionnaire, the wording of items, and the possible answers were finalized.The final questionnaire (comprising 14 questions) is entitled "Questionnaire of sexual quality of life perceived by patients with cutaneous and/or articular psoriasis" (short denomination: Qualipsosex). The quantitative step has not yet been conducted. This step will aim to evaluate the metrologic qualities (reliability, validity, and responsiveness) of the questionnaire and will need to be validated according to the consensus-based standards for the selection of health measurement instrument checklist.

A Qualitative Investigation of the Impact of Acne on Health-Related Quality of Life (HRQL): Development of a Conceptual Model

INTRODUCTION

The negative impact of acne on aspects of health-related quality of life (HRQL) has been demonstrated in many quantitative studies; however, there has been relatively little qualitative research exploring the impact of acne and the use of topical treatment. The study aimed to explore the impact of moderate-severe acne on HRQL in adolescents and adults with inflammatory and non-inflammatory lesions and to develop a conceptual model to illustrate the impact. In addition, the study aimed to identify the attributes of topical acne treatments that are most important for patients.

METHODS

Thirty-four adolescents and 16 adults with moderate-severe acne who were currently/recently prescribed topical treatment were recruited in this cross-sectional qualitative study in the UK, Italy, and Germany. In-depth, semi-structured telephone interviews explored patients' experiences of acne and the impact it has on their HRQL, and their experience of topical treatments for acne. Data were analyzed using thematic analysis and a conceptual model was developed.

RESULTS

The analysis identified seven main areas of HRQL that are affected by acne: emotional functioning, social functioning, relationships, leisure activities, daily activities, sleep, and school/work. Also common throughout the interviews was the perception and reaction to acne from others, which potentially had an impact on all areas of HRQL. The conceptual model illustrates the impact on HRQL and the links between HRQL domains. For both adolescents and adults, it was most important for acne treatments to be fast-acting, non-irritating, and non-bleaching.

CONCLUSION

The results of this qualitative study demonstrate that moderate-severe acne has an extensive impact on adolescents' and adults' HRQL. The conceptual model illustrates the many areas of HRQL that are affected and draws attention to the importance of effective treatments for acne. The study also highlights topical acne treatment attributes that are most important for patients.

FUNDING

Meda, a Mylan company.

Associations between site of skin lesions and depression, social anxiety, body-related emotions and feelings of stigmatization in psoriasis patients

INTRODUCTION

Research has demonstrated a link between psoriasis and a multitude of psychological impairments; however, relatively few studies have examined the importance of site of skin lesions for negative psychological outcomes in psoriasis patients.

AIM

To investigate relationships between anatomical location of psoriatic lesions and experiences of stigmatization, negative emotional attitude towards the body, depression and social anxiety.

MATERIAL AND METHODS

Adult psoriasis patients (N = 193) completed the Stigmatization Scale, the Body Emotions Scale, the Beck Depression Inventory and the Social Anxiety Questionnaire. The body surface area index was used to assess the location and extent of psoriasis.

RESULTS

Feelings of stigmatization were found to be most closely related to the presence of psoriatic lesions on the chest, and the arms and hands. Higher levels of social anxiety were found to be most closely related to the location of psoriatic lesions on the head and neck. Negative emotional attitude towards the body was found to be most closely related to the location of psoriatic lesions on the arms and hands, and on the head and neck. Higher levels of depressive symptoms were most closely related to the presence of psoriatic lesions on the head and neck, the arms and hands, and the genital area.

CONCLUSIONS

The presence of psoriatic lesions on the head, neck, and chest, and also on the arms and hands and the genital area, should alert clinicians to a higher risk of psychological impairments. This may help to better recognize and prevent cumulative life course impairment.

Toward a better understanding of social anxiety and depression in psoriasis patients: The role of determinants, mediators, and moderators

OBJECTIVE

To determine how and under which conditions psoriasis is related to the psychological impairments, in particular, to social anxiety and depression, the current study tested the interplay of selected factors such as gender, age of onset of psoriasis, cognitive and affective elements of body image, experiences of stigmatization, and patients' subjective perceptions of severity of the disease.

METHODS

Adult psoriasis patients (N=193) completed the Appearance Schemas Inventory-Revised, the Stigmatization Scale, the Body Emotions Scale, the Beck Depression Inventory, and the Social Anxiety Questionnaire. The disease severity was defined based on the Body Surface Area (BSA) index.

RESULTS

The effect of psoriasis on social anxiety was moderated by age of onset: higher severity of the disease was associated with higher levels of social anxiety, but only for patients with pre-adult onset psoriasis. Hierarchical multiple regressions revealed that in patients with adult-onset (≥18years of age) the importance of appearance to one's sense of self-worth was the main contributor to social anxiety, while in patients with pre-adult onset, social anxiety was most strongly related to experiences of stigmatization. Moreover, the results indicated that negative body-related emotions mediated the relationship between severity of the disease and depression. Additionally, the relationship between severity of psoriasis and body image emotions was moderated by gender.

CONCLUSIONS

Findings significantly extend previous studies by confirming and highlighting the role of age of onset of psoriasis in psychological impairments, and provide more insight into factors that contribute to social anxiety in this group of patients.

The relationship between psoriasis and depression: A multiple mediation model

This study examined the relationship between psoriasis and depression, proposing a multiple mediation model to analyse the relationship. A total of 193 patients with psoriasis aged 20-67 years completed the Beck Depression Inventory, the Stigmatization Scale, the Appearance Schemas Inventory-Revised, and the Body Emotions Scale. The Body Surface Area index was used to assess severity of psoriasis. Serial multiple mediation analysis revealed that experiences of stigmatization, maladaptive beliefs about appearance and its salience to one's self-evaluation, and negative emotional attitudes towards the body, jointly, sequentially mediated the relationship between the presence of skin lesions of psoriasis and depressive symptoms. These results highlight the importance of the associations between stigmatization and cognitive and affective aspects of body image in relation to depression in patients with psoriasis. We suggest that prevention and intervention programs for psoriasis patients that target body image enhancement would be worthy of further research.

Interventions to increase adherence to acne treatment

BACKGROUND

Adherence to acne medication is poor and is a major reason why treatment plans are ineffective. Recognizing solutions to nonadherence is critical.

OBJECTIVE

The purpose of this study is to describe the hurdles associated with acne nonadherence and to provide mechanisms on how to ameliorate them.

METHODS

PubMed database was searched. Of the 419 search results, 29 articles were reviewed to identify hurdles to adherence and corresponding solutions.

RESULTS

Hurdles to primary nonadherence where the medication is not even started, include lack of knowledge, confusion about usage, weak physician-patient relationship, fear of adverse reactions, and cost. Secondary nonadherence hurdles where the medication is started but is not taken as directed include lack of results, complex regimens, side effects, busy lifestyle, forgetfulness, inconvenience, and psychiatric comorbidity. Solutions to these hurdles include treatment simplification, technology, and dynamic education.

LIMITATIONS

Adherence is affected by numerous factors, but available literature analyzing acne adherence and interventions to improve adherence to treatment is limited.

CONCLUSION

There are several hurdles in adhering to acne treatment. Recognition of these hurdles and finding appropriate solutions may be as important to treatment outcomes as choosing the right medication to prescribe.

[Dermatological diseases and sexuality. How to proceed?]

A variety of dermatological diseases is associated with male or female sexual dysfunction. Some sexual disorders are caused organically; erectile dysfunction in men with systemic sclerosis may be due to penile vascular alterations and corporal fibrosis. Other dermatoses such as psoriasis are associated with risk factors (metabolic syndrome) for sexual disorders and may therefore indirectly induce erectile dysfunction. However, the majority of sexual dysfunctions in dermatological patients is caused by reduced self confidence and sexual self esteem leading to affected partnership and sexuality. Dermatologists should be trained in basic sexual medicine and ask their patients for sexual problems. They may not treat sexual disorders, but they should be identified as sympathetic physicians for these problems and should be able to refer the patient to specialists in sexual medicine.

Distribution pattern of psoriasis, anxiety and depression as possible causes of sexual dysfunction in patients with moderate to severe psoriasis

BACKGROUND:

Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relation. However, beyond genital psoriasis, the importance of the disease's distribution patterns has not been considered.

OBJECTIVES:

To research sexual function in psoriasis patients and investigate the roles of anxiety, depression and psoriasis' distribution patterns in sexual dysfunction.

METHODS:

A comparative study matched for sex and age was performed. Eighty patients with moderate to severe psoriasis and 80 healthy controls were included. The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index.

RESULTS:

Psoriasis was associated with sexual dysfunction, odds ratio=5.5 (CI 95% 2.6-11.3; p<0.001). Certain distribution patterns of psoriasis, involving specific body regions, were associated with an increase in sexual dysfunction in the group presenting the disease, odds ratio 7.9 (CI 95% 2.3-33.4; p<0.001). Multivariate logistic regression analysis identified anxiety and depression, and the involvement of these specific areas, as possible independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis.

CONCLUSION:

This study identifies body areas potentially related to sexual dysfunction, independently of anxiety and depression, in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when choosing the treatment for psoriasis patients.

'I sort of balance it out'. Living with facial acne in emerging adulthood

Many emerging adults live with mild-to-moderate visible facial acne, but little is known about their experiences. A qualitative interview study was conducted with 11 adults aged 18-22 years, which aimed to explore the meaning of living with visible acne. A thematic analysis revealed three superordinate themes: coping strategies, self-perceptions and interpersonal relationships. Results revealed the utility of researching visible acne in emerging adulthood, including the use of multiple coping strategies. Health psychologists need to consider individual differences for young adults who are living with a visible difference. The importance of the peer group and family is also explicated.

Psoriasis and Sexual Behavior in Men: examination of the National Health and Nutrition Examination Survey (NHANES) in the United States

INTRODUCTION

Epidemiologic data on sexual behavior in psoriasis patients are lacking.

AIM

We aim to examine and compare the sexual behaviors between men with and without psoriasis in the United States.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006 and 2009 to 2010. Responses from male participants to the dermatology and sexual behavior questionnaires of the NHANES were collated and analyzed.

MAIN OUTCOME MEASURES

Outcome measures included sexual orientation, age of first sexual encounter, number of oral and non-oral sexual partners, and frequency of unprotected sex.

RESULTS

Among 6,444 U.S. men that responded to the psoriasis question, 170 (2.6%) reported a physician-given diagnosis of psoriasis. Heterosexual men accounted for 95.5% and nonheterosexual men 4.5% of the overall study population. On multivariate analysis, psoriasis was not associated with differences in sexual orientation (odds ratio 1.78, 95% confidence interval [CI] 0.75-4.15). Heterosexual men with psoriasis experienced first sexual encounter at an earlier age than those without psoriasis (weighted difference -0.9 years, P = 0.002). Heterosexual men with psoriasis had significantly fewer female oral sexual partners compared with heterosexual men without psoriasis on multivariate analysis (lifetime partner number: rate ratio [RR] 0.65, 95% CI 0.45-0.95; past-year partner number: RR 0.64, 95% CI 0.42-0.97). No significant differences existed between heterosexual men with and without psoriasis regarding frequency of unprotected sex (RR 0.96, 95% CI 0.85-1.09). Among nonheterosexual men with and without psoriasis, no significant differences existed in age first had sex, number of sexual partners, or frequency of unprotected sex.

CONCLUSION

Heterosexual men with psoriasis have significantly fewer lifetime female oral sexual partners compared with those without psoriasis. Dermatologists and other healthcare providers need to examine the genital region routinely and initiate appropriate therapy to improve patients' sexual health.

Quality of life in pediatric dermatology

Skin disease is highly prevalent in the United States, and it has been well-documented that patients with skin disease experience financial, psychological, social, and quality-of-life (QoL) burdens beyond those of the general population. Pediatric patients and their caregivers are particularly vulnerable to the burden of skin disease. Over the past decade disease-specific indices for QoL measurement in pediatric dermatology have been developed. Most of this research has focused on acne, atopic dermatitis, hemangiomas, ichythosis, psoriasis, and vitiligo. This article provides an overview of QoL assessment in pediatric dermatology for these six conditions.

Psoriasis and sexual behavior in U.S. women: an epidemiologic analysis using the National Health and Nutrition Examination Survey (NHANES)

INTRODUCTION

Although sexual behavior is an integral part of most adults' overall well-being, this aspect of psoriasis patients' quality of life is rarely explored.

AIM

The aim of this study is to assess the relationship between psoriasis and sexual behavior in U.S. women.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006. Our study focuses on responses to the dermatology and sexual behavior questionnaires of the NHANES.

MAIN OUTCOME MEASURES

This study examines the association between psoriasis and sexual behavior in U.S. women with regard to sexual orientation, age of first sexual encounter, number of sexual partners, and frequency of unprotected sex.

RESULTS

A total of 3,462 women provided responses to their psoriasis status: 2,753 (80%) women were heterosexual and 709 (20%) were nonheterosexual. Among them, 2.7% reported a physician-given diagnosis of psoriasis. On multivariate analyses, psoriasis was not associated with differences in sexual orientation (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.62-2.01). Among nonheterosexual women, multivariate analysis revealed a lower number of lifetime female sexual partners in women with psoriasis (rate ratio [RR] 0.11, 95% CI 0.04-0.33, P = 0.001). Among heterosexual women, no significant differences existed between those with and without psoriasis in age of first sexual encounter (weighted difference -0.54 years, 95% CI -1.27 to 0.19), number of lifetime male sexual partners (RR 1.19, 95% CI 0.69-2.06), or number of lifetime male oral sex partners (RR 0.72, 95% CI 0.40-1.29). Heterosexual women with psoriasis had 1.13 times more unprotected sex (RR 1.13, 95% CI 1.02-1.24, P = 0.03) compared with those without psoriasis.

CONCLUSION

Psoriasis is associated with a significantly reduced number of sexual partners in nonheterosexual women. Psoriasis may differentially impact sexual behavior based on sexual orientation in women.

Psoriasis, a model of dermatologic psychosomatic disease: psychiatric implications and treatments

Psoriasis is a common dermatologic disorder with psychiatric comorbidity that often goes undetected and untreated. Psoriasis has higher associations with psychiatric illness than do other dermatologic conditions. We conducted a comprehensive qualitative review of all published medical literature on psoriasis and psychiatric comorbidities since 2005. We found that psoriasis patients suffer psychiatric and psychosocial morbidity that is not commensurate with the extent of cutaneous lesions. Biologic therapies and nonpharmacologic psychosocial interventions show promise in treating comorbid psychiatric illness. The main limitations of this review are the low quality of published studies and the infrequent use of basic science endpoints in reporting treatment outcomes. The literature examining the psychiatric comorbidity of psoriasis is expanding but remains of variable quality. Stronger studies will be necessary to more accurately estimate comorbidities and help identify and comprehensively treat suffering patients.

The romantic experiences of adolescents with a visible difference: Exploring concerns, protective factors and support needs

Injuries or conditions that affect appearance can increase adolescents’ risk of psychosocial and interpersonal difficulties and may also impact on romantic relationships – an important aspect of adolescent development. A mixed method online approach explored the romantic experiences of 40 adolescents with a variety of visible differences. Young people identified appearance-related romantic concerns that cause distress, and impede the development and enjoyment of romantic relations. In contrast, some shared positive experiences and evidence of attitudes and behaviours that appear to protect against these concerns. Adolescents requested online peer support specific to their appearance-related needs. These findings can inform intervention development.