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Day T, Chapman-Burgess E, Scurry J. Clinicopathologic Overlap of Vulvar Psoriasis and Candidiasis. J Low Genit Tract Dis 2024; 28:175-182. [PMID: 38518215 DOI: 10.1097/lgt.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES The study's aim is to assess if vulvar psoriasis and candidiasis may be distinguished by clinical presentation and histopathologic appearance. METHODS The pathology database identified biopsies with corneal or subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate. Exclusions were age younger than 18 years and unavailable or uninterpretable slides. Clinical data included demographics, comorbid conditions, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, thickness, and characteristics of stratum corneum and epidermis, distribution of neutrophils, and infiltrate. Cases were stratified by microbiologic presence or absence of Candida albicans. RESULTS Biopsies from 62 women with median age of 60 years were associated with C. albicans on vulvovaginal culture in 28 (45%), whereas 26 (42%) were negative, and 8 (13%) lacked microbiologic assessment. Swab-positive women were more likely to have diabetes, receive prereferral estrogen, and report vulvar pain. Specialist clinical impression was candidiasis in 33 (53%), psoriasis in 11 (18%), comorbid candidiasis and psoriasis in 7 (11%), dermatitis in 10 (16%), and unknown in 2 (3%). Visible fungal organisms occurred in 16 (26%) cases and were associated with diabetes and satellite lesions. Other than presence of organisms, there were no histopathologic differences stratified by microbiologic result. CONCLUSIONS The histopathologic triad of corneal/subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate is common to vulvar psoriasis and candidiasis, and clinical features do not reliably distinguish between them. Microbiologic assessment and single-agent treatment are useful strategies to clarify the diagnosis.
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Affiliation(s)
| | - Erika Chapman-Burgess
- Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
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Merola JF, Parish LC, Guenther L, Lynde C, Lacour JP, Staubach P, Cheng S, Paris M, Picard H, Deignan C, Jardon S, Chen M, Papp KA. Efficacy and safety of apremilast in patients with moderate-to-severe genital psoriasis: Results from DISCREET, a phase 3 randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol 2024; 90:485-493. [PMID: 37852306 DOI: 10.1016/j.jaad.2023.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Genital psoriasis can be stigmatizing, is highly prevalent among patients with psoriasis, and has limited treatment options. Apremilast is a unique oral immunomodulating phosphodiesterase 4 inhibitor approved for psoriasis treatment. OBJECTIVE To assess the efficacy and safety of apremilast 30 mg twice daily in patients with genital psoriasis. METHODS DISCREET, a phase 3, placebo-controlled trial (NCT03777436), randomized patients with moderate-to-severe genital psoriasis (stratified by affected body surface area <10% or ≥10%) to apremilast or placebo for a 16-week period, followed by an apremilast extension period. Week 16 results are presented. RESULTS Patients were randomized to apremilast (n = 143) or placebo (n = 146). At Week 16, 39.6% and 19.5% of apremilast and placebo patients, respectively, achieved a modified static Physician Global Assessment of Genitalia response (primary endpoint; score of 0/1, ≥2-point reduction); treatment difference was significant (20.1%, P = .0003). Improvements in genital signs and symptoms, skin involvement, and quality of life were observed. Common treatment-emergent adverse events were diarrhea, headache, nausea, and nasopharyngitis. LIMITATIONS Lack of active-comparator. CONCLUSIONS Apremilast demonstrated statistically and clinically meaningful genital Physician Global Assessment responses and improvement of signs, symptoms, severity, and quality of life in this first randomized, controlled study of an oral systemic treatment in patients with genital psoriasis.
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Affiliation(s)
- Joseph F Merola
- Division of Rheumatology, Department of Dermatology and Department of Medicine and Associate Program Director, Combined Medicine-Dermatology Residency Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | | | | | - Charles Lynde
- Chief Medical Director, Lynde Institute for Dermatology, Markham, Ontario, Canada; Probity Medical Research, Markham, Ontario, Canada
| | | | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Sue Cheng
- Global Development, Amgen Inc, Thousand Oaks, California
| | - Maria Paris
- Global Patient Safety, Amgen Inc, Thousand Oaks, California
| | - Hernan Picard
- Global Development, Amgen Inc, Thousand Oaks, California
| | | | - Shauna Jardon
- Medical Affairs, Amgen Inc, Thousand Oaks, California
| | - Mindy Chen
- Global Development, Amgen Inc, Thousand Oaks, California
| | - Kim A Papp
- Alliance Clinical Trials and Probity Medical Research, Waterloo, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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Edwards SK, Bunker CB, van der Snoek EM, van der Meijden WI. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol 2023; 37:1104-1117. [PMID: 36942977 DOI: 10.1111/jdv.18954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans penis and prepuce and is caused by a range of disparate conditions including infection, dermatoses and premalignancy. OBJECTIVE The main objectives of this guideline are to aid recognition of the symptoms and signs and complications of penile skin conditions and to offer recommendations on the diagnostic tests and treatment for a selected group of these conditions. METHODS The previous guideline was updated following a literature review and priority was given to randomized controlled trial and systematic review evidence. RESULTS The updated guideline includes amended management for infective balanitis to provide clear guidance for Group A streptococcal infections, management of on going Lichen sclerosus (to include circumcision and supportive management to reduce the recurrence of genital herpes and warts), additional regimens for Zoonoid change, use of calcineurin inhibitors in management and risk of premalignancy and change of nomenclaturefrom Premalignant conditions to Penile Intraepithelial neoplasia (PeIN). CONCLUSION Balanoposthitis has a widerange of causes high quality evidence specific to the management of penile disease is not available for all the conditions described.
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Asogwa FC, Apebende CG, Ugodi GW, Ebo P, Louis H, Ikeuba AI, Asogwa CJ, Gber TE, Ikot IJ, Owen AE. Anti-inflammatory, Immunomodulatory and DFT Evaluation of the Reactivity Indexes of Phytochemicals Isolated from Harungana madagascariensis. CHEMISTRY AFRICA 2022. [DOI: 10.1007/s42250-022-00569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ceccarelli G, Simonacci M. Exclusively genital psoriasis successfully treated with Risankizumab. Dermatol Ther 2022; 35:e15591. [PMID: 35598296 DOI: 10.1111/dth.15591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Marco Simonacci
- Dermatology Unit, Macerata General Hospital, Macerata, Italy
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6
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Day T, Scurry J, Haqshenas G, Murray G, Tran H, Dennerstein G, Garland SM. The Clinicopathologic Challenge of Nonneoplastic Vulvar Acanthosis. J Low Genit Tract Dis 2022; 26:265-270. [PMID: 35543596 PMCID: PMC9232284 DOI: 10.1097/lgt.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate clinicopathologic features of cases demonstrating an acanthotic tissue reaction not clearly consistent with psoriasis, lichen simplex chronicus, mycosis, or condyloma. MATERIALS AND METHODS This is a retrospective pathologic case series of biopsies reported as "benign acanthotic lesion" and "acanthotic tissue reaction" that lacked a clear diagnosis on expert review. Cases with nuclear atypia were excluded. Clinical and histopathologic data were collected, immunohistochemistry for p16 and p53 were obtained, and molecular testing for 28 common anogenital human papillomavirus (HPV) genotypes was undertaken. RESULTS There were 17 cases with a median age of 47 years. Unilaterality and medial location were clinical reasons for diagnostic difficulty. Histopathologic uncertainty often related to lack of papillary dermal fibrosis to support lichen simplex chronicus or psoriasiform lesions without parakeratosis, subcorneal pustules, and/or mycotic elements. Firm pathologic diagnoses were not possible, but 3 groups emerged: favoring chronic dermatitis, favoring psoriasis, and unusual morphologies. p16 results were negative or nonblock positive while p53 was normal or basal overexpressed. Human papillomavirus testing was negative in 12, low positive for HPV 16 in 1, unassessable in 3, and not requested in 1. CONCLUSIONS There is a group of acanthotic tissue reactions that cannot be classified with standard histopathologic assessment. Further clinicopathologic research into unilateral acanthotic lesions may provide insight into separation of psoriasis and mycosis when organisms are absent. Once nuclear atypia is excluded, immunohistochemistry for p16 and p53 and HPV molecular testing do not assist in diagnostic identification.
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Affiliation(s)
- Tania Day
- Maternity and Gynaecology, John Hunter Hospital, Lambton Heights, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - James Scurry
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
- NSW Health Pathology North, John Hunter Hospital, New Lambton Heights, Australia
| | - Gholamreza Haqshenas
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Australia
| | - Gerald Murray
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Australia
| | - Hong Tran
- Vulvar Disorders and Dermatology Clinic, Royal Women's Hospital, Melbourne, Australia
| | | | - Suzanne M. Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Australia
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Licata G, Lazzaro Danzuso GC, Fiorella C, Palazzo G, Calzavara-Pinton P, Argenziano G, Gambardella A. Efficacy, safety, and patient's satisfaction for treatment of genital psoriasis with tildrakizumab: a case series and review of literature. J Eur Acad Dermatol Venereol 2022; 36:e916-e918. [PMID: 35758324 DOI: 10.1111/jdv.18368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gaetano Licata
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | | | - Carmen Fiorella
- Servizio di Dermatologia, Ospedale "Mons. R. Dimiccoli" Barletta, Italy
| | - Giovanni Palazzo
- ASM Ospedale Distrettuale "Angelina Lo Dico" Tinchi, Pisticci, Italy
| | - Piergiacomo Calzavara-Pinton
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive medicine, University of Campania Luigi Vanvitelli Naples, Italy
| | - Alessio Gambardella
- Dermatology Unit, Department of Mental and Physical Health and Preventive medicine, University of Campania Luigi Vanvitelli Naples, Italy
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van der Meijden WI, Boffa MJ, Ter Harmsel B, Kirtschig G, Lewis F, Moyal-Barracco M, Tiplica GS, Sherrard J. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2022; 36:952-972. [PMID: 35411963 DOI: 10.1111/jdv.18102] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Affiliation(s)
- W I van der Meijden
- Department of Dermatology, Betsi Cadwaladr University Health Board, Bangor, UK
| | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - B Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- Gesundheitszentrum Frauenfeld, Frauenfeld, Switzerland
| | - F Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G-S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Wycombe General Hospital, Bucks, UK
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9
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Göblös A, Varga E, Farkas K, Árvai K, Kemény L. Genetic Investigation of Inverse Psoriasis. Life (Basel) 2021; 11:life11070654. [PMID: 34357026 PMCID: PMC8306123 DOI: 10.3390/life11070654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 12/03/2022] Open
Abstract
Inverse psoriasis is considered to be a rare variant of plaque-type psoriasis and is associated with significantly impaired quality of life. Clinical manifestations and treatment options are somewhat different for each subtype. Identifying genetic variants that contribute to the susceptibility of different types of psoriasis might improve understanding of the etiology of the disease. Since we have no current knowledge about the genetic background of inverse psoriasis, whole exome sequencing was used to comprehensively assess genetic variations in five patients with exclusively inverse lesions. We detected six potentially pathogenic rare (MAF < 0.01) sequence variants that occurred in all investigated patients. The corresponding mutated genes were FN1, FBLN1, MYH7B, MST1R, RHOD, and SCN10A. Several mutations identified in this study are known to cause disease, but roles in psoriasis or other papulosquamous diseases have not previously been reported. Interestingly, potentially causative variants of established psoriasis-susceptibility genes were not identified. These outcomes are in agreement with our hypothesis that the inverse subtype is a different entity from plaque-type psoriasis.
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Affiliation(s)
- Anikó Göblös
- MTA-SZTE Dermatological Research Group, Eötvös Loránd Research Network, 6720 Szeged, Hungary;
- Correspondence: ; Tel.: +36-205-541-692
| | - Emese Varga
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary;
| | - Katalin Farkas
- Department of Medical Genetics, University of Szeged, 6720 Szeged, Hungary;
| | | | - Lajos Kemény
- MTA-SZTE Dermatological Research Group, Eötvös Loránd Research Network, 6720 Szeged, Hungary;
- Department of Dermatology and Allergology, University of Szeged, 6720 Szeged, Hungary;
- HCEMM-USZ Skin Research Group, University of Szeged, 6720 Szeged, Hungary
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10
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Calianno G, Esposito M, Fidanza R, Palmieri M, Fargnoli MC. Ixekizumab improves disease severity, clinical symptoms and quality of life in patients with genital psoriasis: A 24-week real-life experience. Dermatol Ther 2021; 34:e14993. [PMID: 34029442 DOI: 10.1111/dth.14993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/12/2021] [Accepted: 05/12/2021] [Indexed: 01/13/2023]
Abstract
Genital psoriasis (GenPs) has been traditionally considered a difficult to treat psoriasis area. Ixekizumab was the first biologic agent demonstrating efficacy and safety in a formal clinical trial on GenPs; however, real-life experiences are limited. To assess real-life effectiveness and safety of ixekizumab in the treatment of GenPs in a case series of patients with moderate-to-severe plaque psoriasis. Adult patients with moderate-to-severe plaque psoriasis involving the genital area received subcutaneous ixekizumab. Evaluation of disease severity, clinical symptoms, and quality of life was performed at baseline, after 4, 16, and 24 weeks of treatment. Assessment tools were: Static Physician's Global Assessment of Genitalia (sPGA-G), Psoriasis Area and Severity Index (PASI) score, Itch Numerical-Rating-Score (Itch-NRS), and Dermatology-Life-Quality-Index (DLQI). Adverse events were recorded. A total of 14 patients were treated with ixekizumab achieving consistent and significant reduction of disease and quality of life parameters, with a mean percentage reduction from baseline to week 24 of 91.4% for sPGA-G, 95.2% for PASI, 95.6% for Itch-NRS, and 93.7% for DLQI. Ixekizumab treatment was well tolerated. Ixekizumab significantly improved disease severity, itch, and quality of life with an acceptable safety profile in a real-life setting in adult patients affected by GenPs.
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Affiliation(s)
- Gianluca Calianno
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Maria Palmieri
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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11
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Sokolovskiy EV, Kokhan MM. Clinical evidence of therapy for genital psoriasis by biologic agents. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Data in the scientific literature on the use of biologic therapy in localized forms of psoriasis elucidate mostly the problems of treatment of palmoplantar, scalp psoriasis and nail psoriasis. At the same time, the number of scientific data on the effect of biological therapy on genital psoriasis is extremely limited. Important that the quality of life on patients with genital psoriasis has very low level, which indicates a significant influence on the psychological and social well-being. At the same time, the limited number of therapeutic approaches makes this problem even more urgent. Unfortunately, special clinical trials for such patients are rather an exception. Ixekizumab has been reported an effectiveness for patients with anogenital psoriasis. New data on the comparative efficacy of ixekizumab and secukinumab give hope us for new opportunity for the treatment of genital psoriasis.
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12
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Raef HS, Elmariah SB. Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front Med (Lausanne) 2021; 8:649402. [PMID: 33898486 PMCID: PMC8058221 DOI: 10.3389/fmed.2021.649402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023] Open
Abstract
Vulvar pruritus is an unpleasant sensation and frequent symptom associated with many dermatologic conditions, including infectious, inflammatory and neoplastic dermatoses affecting the female genitalia. It can lead to serious impairment of quality of life, impacting sexual function, relationships, sleep and self-esteem. In this review, common conditions associated with vulvar itch are discussed including atopic and contact dermatitis, lichen sclerosus, psoriasis and infectious vulvovaginitis. We review the potential physiologic, environmental and infectious factors that contribute to the development of vulvar itch and emphasize the importance of addressing their complex interplay when managing this disruptive and challenging symptom.
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Affiliation(s)
- Haya S Raef
- Tufts University School of Medicine, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
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13
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AlMutairi N, Eassa BI. A Randomized Controlled Ixekizumab Vs Secukinumab Trial to Study the Impact on Sexual Activity in Adult Patients with Genital Psoriasis. Expert Opin Biol Ther 2020; 21:297-298. [PMID: 33115285 DOI: 10.1080/14712598.2021.1843629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: There is limited data on the effects of biologic therapies on genital psoriasis and sexual activity. Recently, Ixekizumab was reported to be effective. Aim: To compare the efficacy of ixekizumab and secukinumab for the treatment of genital psoriasis and sexual inadequacy in adult patients with moderate-to-severe psoriasis. Patients and methods: We assessed adult patients with moderate-to-severe psoriasis having genital involvement. They were randomly assigned in a 1:1 ratio to receive either ixekizumab (80 mg/2 weeks after 160-mg initial dose) or secukinumab (300 mg subcutaneous injection at Weeks 0, 1, 2, 3, and 4 then every 4 weeks). The severity was assessed using Genital Psoriasis Symptoms Scale (GPSS), and impact on sexual health by evaluating the Massachusetts General Hospital-Sexual Functioning Questionnaire (MGH-SFQ). Results: Twenty eight patients on ixekizumab, and 26 on secukinumab showed improvement in genital psoriasis symptoms, beginning week 2 (GPSS total and individual items), and from week 4 onwards, improvement in sexual activity was seen with both drugs. Conclusion: Both genital psoriasis symptoms and impact on sexual activity improved rapidly and significantly with both the IL-17 inhibitors. Limitations included small number of patients and lack of follow-up period.
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Affiliation(s)
- Nawaf AlMutairi
- Department of Medicine, Faculty of Medicine, Kuwait University , Kuwait City, Kuwait
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14
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Young TK, Gutierrez D, Zampella JG. An Overview of Penile and Scrotal Dermatoses. Urology 2020; 142:14-21. [DOI: 10.1016/j.urology.2020.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/22/2020] [Accepted: 04/05/2020] [Indexed: 11/16/2022]
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15
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Lacarrubba F, Borghi A, Verzì AE, Corazza M, Stinco G, Micali G. Dermoscopy of genital diseases: a review. J Eur Acad Dermatol Venereol 2020; 34:2198-2207. [PMID: 32531092 DOI: 10.1111/jdv.16723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022]
Abstract
The male and female external genital regions are anatomical areas in which various types of skin disorders may occur. Although most of these conditions can be diagnosed by means of clinical examination and an accurate medical history, in most cases further investigations with time-consuming and/or invasive procedures are needed in order to reach the correct diagnosis. Dermoscopy, as a modern non-invasive tool, is able to better diagnose pigmented and non-pigmented skin tumours along with various inflammatory and infectious skin and appendage disorders. The aim of this paper was to provide a review of the use of dermoscopy in genital disorders based on published data and to include personal experience gained from real life, focusing on any possible gender difference and whether disease mucosal/semimucosal dermoscopy features may differ from those observed on the skin. In conclusion, genital dermoscopy should always be considered during clinical inspection in order to enhance the diagnosis or to rule out those conditions that may look similar but that show a different dermoscopy pattern, thus narrowing down the differential diagnoses and avoiding unnecessary invasive investigations.
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Affiliation(s)
- F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - A Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - A E Verzì
- Dermatology Clinic, University of Catania, Catania, Italy
| | - M Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - G Stinco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
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16
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Sex-related impairment and patient needs/benefits in anogenital psoriasis: Difficult-to-communicate topics and their impact on patient-centred care. PLoS One 2020; 15:e0235091. [PMID: 32609733 PMCID: PMC7329077 DOI: 10.1371/journal.pone.0235091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Genital psoriasis affects 2-5% of psoriasis patients; generalised plaque or intertriginous psoriasis also affects the genital area in 29-40% of cases. Anogenital psoriasis has been associated with significant quality of life impairments, but little is known about specific patient needs/treatment goals. This study aimed to examine the overall and sex-related disease burden, patient needs and treatment benefits in patients with anogenital psoriasis, compared to patients with psoriasis not affecting the anal/genital areas. Within the cross-sectional nationwide survey, 2,009 participants were consecutively recruited in 157 randomly assigned German dermatology practices and clinics, according to the following inclusion criteria aged 18 years or over; diagnosis of psoriasis vulgaris; ability to answer the questionnaires; and written informed consent. Based on a high-resolution grid on the topical distribution of psoriasis, two groups were formed: anogenital psoriasis (n = 622) and comparison group (n = 1,303). Clinical severity was assessed by the Psoriasis Area and Severity Index (PASI). Patients completed the EuroQoL visual analogue scale (EQ VAS), the Dermatology Life Quality Index (DLQI), and the Patient Benefit Index (PBI). Patients with anogenital psoriasis had higher PASI (13.0±10.6 vs. 8.9±7.6, P < 0.001) and more DLQI impairments (8.9±6.9 vs. 7.0±6.2, P = 0.002) than controls. At the item-level, they also reported more sex-related DLQI impairments (DLQI-i9: 0.5±0.8 vs. 0.3±0.7, P < 0.001) and treatment needs (PBI-i17: 2.2±1.8 vs. 1.9±1.8, P = 0.001). A great percentage of missing/not-relevant responses was found for sex-related items (23.3-41.9%). These results suggest that the assessment of sex-related impairments and treatment needs should be prioritised in patients with anogenital psoriasis. Questionnaires may be used as a less uncomfortable way for patients to discuss their genital lesions and sexual function during healthcare visits. However, the great percentage of missing/not-relevant responses to sex-related items calls for in-depth assessments and effective patient-physician communication regarding these sensitive topics.
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Abstract
PURPOSE OF REVIEW The purpose of this review was to explore mechanisms, causes, and therapies of itchy conditions involving organs beyond the skin including the eyes, ears, nose, and genital region. RECENT FINDINGS Conditions which cause itch in these locations vary from skin diseases that extend to these areas (i.e., atopic dermatitis, seborrheic dermatitis, and psoriasis) to allergic conditions (i.e., allergic rhinitis and conjunctivitis) and to neuropathic conditions that relate to afferent nerve fiber damage (i.e., lumbosacral radiculopathies in genital disease) as well as some psychological components. Similar to the skin, itch in these locations involves a complex interaction between epithelial cells, unmyelinated C nerve fibers, and cytokines. There is also a significant component of neural sensitization phenomena. Mechanisms of itch beyond the skin are currently an understudied topic that affects millions of patients. Future research should be done in order to further understand the pathophysiology of itch in these body sites.
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Affiliation(s)
- Rachel Shireen Golpanian
- Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Peter Smith
- School of Medicine and Griffith Health Institute, Griffith Health, Griffith University, Gold Coast Campus, Southport, QLD, 4215, Australia
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA.
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18
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Egeberg A, See K, Garrelts A, Burge R. Epidemiology of psoriasis in hard-to-treat body locations: data from the Danish skin cohort. BMC DERMATOLOGY 2020; 20:3. [PMID: 32434510 PMCID: PMC7238562 DOI: 10.1186/s12895-020-00099-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/10/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Having psoriasis in hard-to-treat areas, i.e. the scalp, face, palms, soles, nails, and genitals, respectively, can impair patients' quality of life. We investigated the prevalence of hard-to-treat body locations of psoriasis, and described patients' clinical and demographic characteristics, and quality of life impacts in a population-based cohort. METHODS We performed a cross-sectional study using a total of 4016 adults (≥18 years) with psoriasis from the Danish Skin Cohort. Groups were compared to patients without involvement of hard-to-treat areas. RESULTS The most frequently affected hard-to-treat area was the scalp (43.0%), followed by the face (29.9%), nails (24.5%), soles (15.6%), genitals (14.1%), and palms (13.7%), respectively. Higher prevalence was generally seen with increasing psoriasis severity. Among all patients 64.8, 42.4, and 21.9% of patients had involvement of ≥1, ≥2, or ≥ 3 hard-to-treat areas. Those with involvement of certain hard-to-treat areas such as hands, feet, and genitals had clinically relevant DLQI impairments. Having involvement of one hard-to-treat area was significantly associated with other hard-to-treat areas affected even after adjusting for age, sex, and psoriasis severity. CONCLUSION Psoriasis commonly affects hard-to-treat locations, even in patients with mild disease. For some of these areas, patient-reported disease burden, e.g. as measured by DLQI, is impaired.
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Affiliation(s)
- Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark.
| | - Kyoungah See
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, Indiana, USA.,Division of Pharmaceutical Sciences, University of Cincinnati, Cincinnati, OH, USA
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19
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Conforti C, Giuffrida R, Di Meo N, Longone M, Vichi S, Colli C, Deinlein T, Vezzoni R, Retrosi C, Errichetti E, Cannavò SP, Zalaudek I, Dianzani C. Benign dermatoses of the male genital areas: A review of the literature. Dermatol Ther 2020; 33:e13355. [PMID: 32239734 DOI: 10.1111/dth.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
Abstract
The male genitalia are a common site of dermatoses. Patients with penile diseases often delay or avoid medical care due to anxiety and embarrassment. In this narrative review, we describe some of the main benign dermatoses localized to male genital, focusing on their epidemiology, clinical and dermoscopic features, as well as available therapies.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Nicola Di Meo
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Michela Longone
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Silvia Vichi
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Claudia Colli
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Teresa Deinlein
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Roberta Vezzoni
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Chiara Retrosi
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | | | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Caterina Dianzani
- Department of Plastic Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, Italy
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20
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Thomas C, Matthies M, Homey B, Meller S. [Intertriginous psoriasis]. Hautarzt 2020; 71:263-268. [PMID: 32144441 DOI: 10.1007/s00105-020-04558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intertriginous psoriasis is a variant of psoriasis that is associated with inflammatory lesions in skin folds. Patients often feel ashamed, are subjected to stigmatization, social isolation, or experience mental health issues. There is no general consensus on the definition of intertriginous psoriasis. Depending on the definition used, the prevalence varies substantially. Due to the particular location of skin lesions, therapeutic management is very challenging. Mild symptoms can be treated with topical corticosteroids or topical immunomodulators. There are encouraging data demonstrating the efficacy of ixekizumab, possibly charting the way for it to become a systemic treatment option.
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Affiliation(s)
- C Thomas
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - M Matthies
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - B Homey
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - S Meller
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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21
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Anti-psoriatic and immunomodulatory evaluation of psorospermum febrifugum spach and its phytochemicals. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2019.e00229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Merola JF, Ghislain PD, Dauendorffer JN, Potts Bleakman A, Brnabic AJM, Burge R, Riedl E. Ixekizumab improves secondary lesional signs, pain and sexual health in patients with moderate-to-severe genital psoriasis. J Eur Acad Dermatol Venereol 2020; 34:1257-1262. [PMID: 31919919 PMCID: PMC7318177 DOI: 10.1111/jdv.16181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022]
Abstract
Background Epithelial surface disruption in genital psoriatic lesions may manifest as erosions, fissures and/or ulcers, causing pain and significantly impacting a patient's sexual health. Objective To evaluate the impact of erosions, fissures and/or ulcers in genital psoriatic lesions on pain and sexual activity in patients with moderate‐to‐severe genital psoriasis (GenPs) and treatment responses to ixekizumab vs. placebo until Week 12. Methods This post hoc subgroup analysis of patients presenting with and without erosions, fissures and/or ulcers in genital lesions from a phase IIIb multicentre, randomized, double‐blind, placebo‐controlled study (IXORA‐Q; NCT02718898) in 149 adults with moderate‐to‐severe GenPs treated with subcutaneous ixekizumab (80 mg every 2 weeks; n = 75) or placebo (n = 74) evaluated outcomes for clinician‐rated GenPs severity (static Physician's Global Assessment of Genitalia; sPGA‐G) and patient‐reported genital pain and itch (Genital Psoriasis Symptoms Scale; GPSS) and sexual health (Genital Psoriasis Sexual Frequency Questionnaire; GenPs‐SFQ). Results At baseline, 38% (n = 57) of patients presented with genital erosions, fissures and/or ulcers independent of overall body surface area involvement (<10% or ≥10%). These signs were associated with higher scores for disease severity (sPGA‐G) and pain (GPSS) but not sexual health (GenPs‐SFQ). Complete resolution of these signs was observed in 62% of ixekizumab‐treated patients (25% for placebo) at Week 1 and 83% (21% for placebo) at Week 12. Patients treated with ixekizumab reported significant improvements in pain, itch, disease severity and sexual health over 12 weeks compared to placebo and irrespective of the presence/absence of genital erosions, fissures and/or ulcers at baseline. Conclusion Ixekizumab led to rapid and sustained resolution of erosions, fissures and/or ulcers and significant improvements in GenPs severity, genital pain and sexual health. Ixekizumab may help to improve the well‐being of patients with GenPs.
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Affiliation(s)
- J F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P-D Ghislain
- Department of Dermatology, Cliniques Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | - R Burge
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E Riedl
- Eli Lilly and Company, Indianapolis, IN, USA.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
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23
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Gopinath H, Karthikeyan K. Genital scabies: Haven of an unwelcome guest. Indian J Sex Transm Dis AIDS 2020; 41:10-16. [PMID: 33062975 PMCID: PMC7529175 DOI: 10.4103/ijstd.ijstd_69_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/10/2018] [Accepted: 12/30/2019] [Indexed: 11/04/2022] Open
Abstract
The itch mite Sarcoptes scabiei var. hominis has been a menace to humanity for ages. Diagnosing scabies can be a challenge in view of the varied presentations of the disease. The male genitalia are an important area of predilection of the mite. Examination of this often overlooked area is essential as it may reveal both characteristic and atypical manifestations of scabies. Genital involvement also attains special relevance in view of the possible sexual transmission of the mite. In addition to the morbidity caused by itching, patients may have to deal with myths, stigma, and embarrassment.
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Affiliation(s)
- Hima Gopinath
- Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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24
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de Belilovsky C, Bohbot JM. Effects of a topical ointment on responses to treatments used for common genital diseases and on quality of life. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1795964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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25
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Burlando M, Herzum A, Carmisciano L, Cozzani E, Parodi A. Biological therapy in genital psoriasis in women. Dermatol Ther 2019; 33:e13110. [DOI: 10.1111/dth.13110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/07/2019] [Accepted: 10/04/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Martina Burlando
- DISSAL Department of DermatologyOspedale Policlinico San Martino Genoa Italy
| | - Astrid Herzum
- DISSAL Department of DermatologyOspedale Policlinico San Martino Genoa Italy
| | - Luca Carmisciano
- Section of Biostatistics, Department of Health Sciences (DISSAL)University of Genoa Genoa Italy
| | - Emanuele Cozzani
- DISSAL Department of DermatologyOspedale Policlinico San Martino Genoa Italy
| | - Aurora Parodi
- DISSAL Department of DermatologyOspedale Policlinico San Martino Genoa Italy
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26
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da Silva N, von Stülpnagel C, Langenbruch A, Danckworth A, Augustin M, Sommer R. Disease burden and patient needs and benefits in anogenital psoriasis: developmental specificities for person-centred healthcare of emerging adults and adults. J Eur Acad Dermatol Venereol 2019; 34:1010-1018. [PMID: 31715033 DOI: 10.1111/jdv.16076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Establishing romantic relationships involving cohabitation and/or sexual intercourse is an overriding task for many people during emerging adulthood, i.e. from their late teens through the twenties. The diagnosis of anogenital psoriasis may hinder social/intimate relationships, resulting in higher disease burden in this age group. OBJECTIVES To compare the disease burden and patient needs/benefits between emerging adults (18-30 years) and adults (>30 years) with psoriasis, with and without anogenital involvement; and to identify sociodemographic/clinical variables accounting for better patient-reported outcomes. METHODS Patients aged ≥18 years with psoriasis vulgaris were recruited within a cross-sectional nationwide survey randomly assigning 157 dermatology practices/clinics in Germany. Anogenital involvement was established based on a high-resolution grid on the topology of psoriasis. The main outcome measures were the Psoriasis Area and Severity Index (PASI), the EuroQoL visual analogue scale (EQ-VAS), the Dermatology Life Quality Index (DLQI) and the Patient Benefit Index (PBI). RESULTS Participants were 1921 patients: 173 emerging adults and 1749 adults >30 years. Anogenital involvement was observed in 621 patients (32.3%). Patient with anogenital psoriasis reported decreased health and more QoL impairments compared with those without anogenital lesions. Emerging adults presented more QoL impairments and less treatment benefits than older patients, and they were more prone to underrate a wide range of needs, except when the anogenital area was affected. Beyond anogenital involvement and higher disease severity, less treatment benefits were associated with more QoL impairments, particularly for emerging adults. CONCLUSIONS The developmental instability of many emerging adults may result in difficulties to establish/adhere to treatment goals and thus in decreased perception of treatment benefit and more QoL impairments. Anogenital involvement is a risk factor for increased disease burden regardless of age. Assessing anogenital involvement in all patients and helping younger patients to define/adhere to treatment goals should be prioritized in patient-centred healthcare for psoriasis.
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Affiliation(s)
- N da Silva
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C von Stülpnagel
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Langenbruch
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Danckworth
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - R Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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27
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Abstract
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.
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Affiliation(s)
- Aine Kelly
- Dermatology Department, St. Vincent's University Hospital, Elm Park Rd, Dublin 4, Ireland.
| | - Caitriona Ryan
- Dermatology Department, St. Vincent's University Hospital, Elm Park Rd, Dublin 4, Ireland
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28
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Abstract
Fibroepithelial stromal polyps of vulva are the type of mesenchymal lesion that typically occurs in women of reproductive period. They are common, usually small and hystologically benign. Larger lesions are rare and likely arise from proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer of the lower genital tract. We present a case of 16 year old female with a giant polypoid lesion of the vulva localized on the right labium. The mass measure was 18×12×3 cm. Total surgical resection of the lesion was performed. Histopathological examination reported a fibroepithelial stromal polyp of the vulva. The patient showed no evidence of recurrence four years after the resection. Fibroepithelial polyps of the vulvar region are benign lesions that have a wide range of morphologic appearances and may be misinterpreted as malignant. Total excision is the best treatment options and histopathological examination is strongly recommended to rule out a malignant neoplasm.
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29
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Damiani G, Cazzaniga S, Conic RR, Naldi L. PRURITUS CHARACTERISTICS IN A LARGE ITALIAN COHORT OF PSORIATIC PATIENTS. J Eur Acad Dermatol Venereol 2019; 33:1316-1324. [PMID: 31736536 PMCID: PMC6857445 DOI: 10.1111/jdv.15539] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/18/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Psoriasis (Ps) is a chronic systemic autoimmune disease associated with pruritus in 64-98% of patients. However, few modestly sized studies assess factors associated with psoriatic pruritus. OBJECTIVE To investigate factors associated with Ps pruritus intensity. METHODS Psoriasis patients 18 years or older seen in one of 155 centers in Italy between September 2005 and 2009 were identified from the Italian PsoCare registry. Patients without cutaneous psoriasis and those with missed information on pruritus were excluded. RESULTS We identified 10,802 patients, with a mean age 48.8±14.3 years. Mild itch was present in 33.2% of patients, moderate in 34.4%, severe in 18.7% and very severe in 13.7%. Higher itch intensity was associated with female gender, lower educational attainment compared to university degree, pustular psoriasis, psoriasis on the head, face, palmoplantar areas, folds and genitalia, more severe disease, disease duration <15 years, and no or few prior systemic treatments. LIMITATIONS Effects of specific medication on itch were not assessed. CONCLUSIONS Pruritus should be evaluated during psoriasis visits, and physicians should be aware of patients at higher risk for itch. Further studies are needed to assess the effects of medications on itch, and establish therapy for psoriasis patients with persistent itch.
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Affiliation(s)
- Giovanni Damiani
- Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo, Italy
- Centro Studi GISED, Bergamo, Italy
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Rosalynn Rz Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
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31
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Reynolds KA, Pithadia DJ, Lee EB, Wu JJ. Treatments for inverse psoriasis: a systematic review. J DERMATOL TREAT 2019; 31:786-793. [PMID: 31100992 DOI: 10.1080/09546634.2019.1620912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Inverse psoriasis often requires a targeted treatment strategy due to the inherent sensitivity, thinness, and occlusion of flexural areas. However, most treatment recommendations are based on anecdotal evidence.Methods: A systematic literature search was conducted in October 2018 in Pubmed, Scopus, Embase, and Cochrane Library with keywords 'inverse psoriasis,' 'genital psoriasis,' and 'treatment.' All prospective studies assessing efficacy of treatments for inverse psoriasis that had a sample size of at least 10 patients were included in our analysis.Results: The initial search yielded 340 results, and 14 studies were included in the final analysis. These studies comprised over 1000 patients with mild to severe psoriasis involving axillary, inframammary, facial, and/or anogenital regions. The included studies demonstrated efficacy of topical immunomodulators (N = 7), vitamin D analogs (N = 4), topical corticosteroids (N = 3), antiseptics (N = 2), and biologics (N = 1) in improving genital and flexural psoriasis symptoms.Conclusions: There is a paucity of high-quality studies on which to base treatment recommendations, especially with regard to the role of systemic and biologic therapies. Few studies, many of which are of low evidence quality, suggest that topical immunomodulators, vitamin D analogs, and mid-to-high-potency topical corticosteroids may be effective treatments, but more randomized controlled trials are needed.
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Affiliation(s)
- Kelly A Reynolds
- Univeristy of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Deeti J Pithadia
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Erica B Lee
- University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
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32
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García‐Legaz Martínez M, Martínez‐Doménech Á, Hernández‐Bel P, Magdaleno‐Tapial J, Valenzuela‐Oñate C, Pérez‐Pastor G, Sánchez‐Carazo J, Alegre‐de Miquel V, Pérez‐Ferriols A. Successful response of genital psoriasis to ixekizumab: report of six cases. J Eur Acad Dermatol Venereol 2019; 33:e325-e327. [DOI: 10.1111/jdv.15623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Á. Martínez‐Doménech
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
| | - P. Hernández‐Bel
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
| | - J. Magdaleno‐Tapial
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
| | - C. Valenzuela‐Oñate
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
| | - G. Pérez‐Pastor
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
| | - J.L. Sánchez‐Carazo
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
| | - V. Alegre‐de Miquel
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
| | - A. Pérez‐Ferriols
- Department of Dermatology Consorci Hospital General Universitari de Valencia València Spain
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33
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Augustin M, Sommer R, Kirsten N, Danckworth A, Radtke M, Reich K, Thaci D, Boehncke W, Langenbruch A, Mrowietz U. Topology of psoriasis in routine care: results from high‐resolution analysis of 2009 patients. Br J Dermatol 2019; 181:358-365. [DOI: 10.1111/bjd.17403] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
- M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - R. Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - A. Danckworth
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - K. Reich
- Dermatologikum Berlin and SCIderm Research Institute Hamburg Germany
| | - D. Thaci
- Comprehensive Center for Inflammation Medicine University Hospital Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - W.H. Boehncke
- Department of Dermatology and Venereology Geneva University Hospitals Geneva Switzerland
| | - A. Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - U. Mrowietz
- Department of Dermatology University Medical Center Schleswig‐Holstein Campus Kiel Kiel Germany
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34
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Borghi A, Virgili A, Corazza M. Dermoscopy of Inflammatory Genital Diseases: Practical Insights. Dermatol Clin 2019; 36:451-461. [PMID: 30201154 DOI: 10.1016/j.det.2018.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Diagnosis of genital inflammatory disorders may be difficult for several reasons, such as their similar appearance, possible misdiagnosis with infectious and malignant conditions, and peculiar anatomic conditions that may lead to modification of clinical features. Dermoscopy could be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation. Practical guidance for the use of dermoscopy in the assessment of the main inflammatory genital diseases is provided, namely for lichen sclerosus, lichen planus, psoriasis, lichen simplex chronicus, and plasma cell mucositis.
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Affiliation(s)
- Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy.
| | - Annarosa Virgili
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
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Fadini GP, Sarangdhar M, De Ponti F, Avogaro A, Raschi E. Pharmacovigilance assessment of the association between Fournier's gangrene and other severe genital adverse events with SGLT-2 inhibitors. BMJ Open Diabetes Res Care 2019; 7:e000725. [PMID: 31641524 PMCID: PMC6777404 DOI: 10.1136/bmjdrc-2019-000725] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/14/2019] [Accepted: 09/12/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Sodium glucose cotransporter-2 inhibitors (SGLT2i) exert cardiorenal protection in people with diabetes. By inducing glycosuria, SGLT2i predispose to genital infections. In addition, rare occurrence of Fournier's gangrene (FG) has been reported. We aimed to investigate such association through the U.S. Food and Drug Administration (FDA) adverse event (AE) reporting system (FAERS). RESEARCH DESIGN AND METHODS We mined the FAERS up to 2018q3 (before FDA warning about SGLT2i-associated FG) to retrieve reports including FG as an AE and SGLT2i as suspect or concomitant drugs, and calculated proportional reporting ratios (PRR). RESULTS We retrieved 47 cases of FG and 17 cases of other severe AEs of the genital area associated with SGLT2i. Patients with FG were ~10 years older than those with other severe genital AEs. Overall, 77% occurred in men. Three patients were concomitantly treated with systemic immunosuppressive drugs. Increased reporting frequency emerged for SGLT2i compared with other drugs, with a PRR ranging from 5 to 10. The disproportional reporting of FG with SGLT2i remained robust and consistently significant when restricting to the period when SGLT2i were available, to reports filed for glucose-lowering medications or for drugs with the diabetes indication, and after refining the definition of FG. FG was disproportionally associated with psoriasis and with the combination of immunosuppressants and SGLT2i. CONCLUSIONS Although causality cannot be demonstrated, SGLT2i may predispose to FG and other severe genital AEs. Since the use of SGLT2i is expected to increase significantly, clinicians should be aware of these severe, although rare, AEs and their predisposing factors.
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Affiliation(s)
| | - Mayur Sarangdhar
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Abstract
Psoriasis is a chronic inflammatory dermatosis affecting 1–3% of the general population. Patients with psoriasis represent a heterogeneous population with individual disease expression – different degrees and severity of skin involvement. Psoriatic lesions in particular localizations such as the face, scalp, intertriginous or palmoplantar areas significantly reduce quality of life. Patients often feel ashamed, embarrassed, or self-conscious about their symptoms. Furthermore, genital psoriasis significantly affects sexual health. Among patients with psoriasis, the prevalence of special localizations is estimated to be 23–27% on the nails, 49% on the face, 12–16% on the palms and soles, and up to 36% in intertriginous regions. Due to peculiar features of skin in these areas, adequate and specific management is required, which is discussed in this review.
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Larsabal M, Ly S, Sbidian E, Moyal‐Barracco M, Dauendorffer J, Dupin N, Richard M, Chosidow O, Beylot‐Barry M, Abdo I, Acquitter M, Breteque Mignot MA, Amici J, Archier E, Aubin F, Barthelemy H, Baubion E, Beneton N, Bolac C, Bouilly D, Bourseau‐Quetier C, Brenaut E, Buzenet C, Camus M, Celerier P, Chabbert C, Chamaillard M, Charles S, Darrigade A, Delarue M, Depaire F, Devaux S, Do‐Pham G, Duval‐Modeste A, Fabre F, Fauconneau A, Fite C, Fleuret C, Girard C, Grande S, Guillet S, Hacard F, Hegazy S, Hosteing S, Jacquin M, Jegou M, Joly P, Jouary T, Julien D, Kemula M, Kostrzewa E, Lacour J, Legrain V, Livideanu C, Lu D, Maccari F, Magne F, Martin C, Meunier L, Misery L, Parier J, Pelletier F, Perrussel M, Petit‐Fauconneau A, Peyrot I, Plantin P, Pruvost‐Balland C, Regnier E, Reynier‐Rezzi J, Salzes C, Seneschal J, Shollhammer M, Souteyrand A, Staumont D, Toulemonde A, Vanhaecke C, Vedie A, Versapuech J, Vigan M, Viguier M, Villani A. GENIPSO: a French prospective study assessing instantaneous prevalence, clinical features and impact on quality of life of genital psoriasis among patients consulting for psoriasis. Br J Dermatol 2018; 180:647-656. [DOI: 10.1111/bjd.17147] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M. Larsabal
- Department of Dermatology Bordeaux University Hospital Bordeaux University Bordeaux France
| | - S. Ly
- Department of Dermatology Bordeaux University Hospital Bordeaux University Bordeaux France
- Vulvology Study Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
- Psoriasis Research Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
| | - E. Sbidian
- Psoriasis Research Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
- Department of Dermatology Henri‐Mondor Hospital, Public Assistance – Paris Hospitals (AP‐HP) CréteilFrance
- Virus,Immunity and Cancer University‐Hospital Complex (DHU VIC) EA 7379 Epidemiology in Dermatology and Evaluation of Treatments (EpiDermE) Paris‐Est University Créteil (UPEC) CréteilFrance
| | - M. Moyal‐Barracco
- Vulvology Study Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
- Department of Dermatology Cochin Tarnier Hospital Paris Descartes University ParisFrance
| | - J.‐N. Dauendorffer
- Vulvology Study Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
- Psoriasis Research Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
- Department of Dermatology Saint‐Louis Hospital Paris France
| | - N. Dupin
- Department of Dermatology Cochin Tarnier Hospital Paris Descartes University ParisFrance
- Dermatological Infectiology and Sexually Transmitted Diseases Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
| | - M.A. Richard
- Psoriasis Research Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
- Department of Dermatology Timone Hospital, Public Assistance–Marseille Hospitals Aix‐Marseille University UMR 911, INSERM CRO2, “Centre de recherche en oncologie biologique et oncopharmacologie” Marseille France
| | - O. Chosidow
- Psoriasis Research Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
- Department of Dermatology Henri‐Mondor Hospital, Public Assistance – Paris Hospitals (AP‐HP) CréteilFrance
- Virus,Immunity and Cancer University‐Hospital Complex (DHU VIC) EA 7379 Epidemiology in Dermatology and Evaluation of Treatments (EpiDermE) Paris‐Est University Créteil (UPEC) CréteilFrance
- Dermatological Infectiology and Sexually Transmitted Diseases Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
| | - M. Beylot‐Barry
- Department of Dermatology Bordeaux University Hospital Bordeaux University Bordeaux France
- Psoriasis Research Group of the French Society for Dermatology Maison de la Dermatologie Malherbes Paris France
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Yosipovitch G, Foley P, Ryan C, Cather JC, Meeuwis KA, Burge R, Bleakman AP, Lin CY, Malatestinic W, Gottlieb A. Ixekizumab Improved Patient-Reported Genital Psoriasis Symptoms and Impact of Symptoms on Sexual Activity vs Placebo in a Randomized, Double-Blind Study. J Sex Med 2018; 15:1645-1652. [DOI: 10.1016/j.jsxm.2018.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 02/08/2023]
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Affiliation(s)
- G. Becher
- West Ambulatory Care Hospital; Dalnair St Yorkhill, Glasgow U.K
| | - A.D. Burden
- Institute of Infection, Immunity and Inflammation; University of Glasgow; U.K
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Yang EJ, Beck KM, Sanchez IM, Koo J, Liao W. The impact of genital psoriasis on quality of life: a systematic review. PSORIASIS-TARGETS AND THERAPY 2018; 8:41-47. [PMID: 30214891 PMCID: PMC6118254 DOI: 10.2147/ptt.s169389] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psoriasis is a chronic immune-mediated inflammatory disease with significant medical and psychological comorbidities. In addition to having increased cardiovascular risk and mortality, psoriasis patients are more likely to be depressed, anxious, and endorse suicidal ideation than the general population. These patients often have low self-esteem and feel stigmatized due to their skin disease, which can prevent them from pursuing relationships, dating, and attending social activities. Up to 63% of adult psoriasis patients experience psoriatic lesions on their genital area during their lifetime, but often do not discuss these issues with their physicians due to embarrassment, stigmatization, or shyness about this sensitive location. However, psoriasis in sensitive areas, such as the genitals, may result in quality of life impairment greater than that of patients with psoriasis elsewhere on their body, particularly in respect to romantic relationships, intimacy, and sexual function. This article evaluates the current literature regarding the impact of genital psoriasis on the quality of life of affected patients.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA, .,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA,
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA,
| | - Isabelle M Sanchez
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA, .,University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - John Koo
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA,
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA,
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Abstract
Genital psoriasis affects approximately 63% of psoriasis patients at least once in their lifetime. More than any other area on the body, genital lesions significantly impair patients' psychologic well-being and quality of life. We aimed to systematically review the published evidence on the safety, efficacy, and tolerability of treatments of genital psoriasis and synthesize the available clinical data. A total of 1 randomized controlled trial, 11 open-label studies, and 26 case reports were included in our analysis, representing a total of 458 patients, of which 332 were adults and 126 were children. Topical corticosteroids were commonly used first-line for genital psoriasis and were well tolerated. Nonsteroidal agents, such as topical calcineurin inhibitors or vitamin D analogs, were also efficacious, but were often irritating. One systemic agent, ixekizumab, demonstrated efficacy in reducing genital psoriasis symptoms in a large, randomized, placebo-controlled trial. Various systemic and topical medications may improve genital psoriasis lesions, but there is a lack of high-quality evidence to guide clinical decision-making. Specific reporting of efficacy for genital psoriasis in larger controlled studies of psoriasis treatments are necessary to improve the available evidence regarding the optimal treatment regimen for genital psoriasis.
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Affiliation(s)
- Xiao-Jian Yao
- Department of Dermatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tang-De Zhang
- Department of Dermatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Marcos-Pinto A, Soares-de-Almeida L, Borges-Costa J. Nonvenereal Penile Dermatoses: A Retrospective Study. Indian Dermatol Online J 2018; 9:96-100. [PMID: 29644193 PMCID: PMC5885634 DOI: 10.4103/idoj.idoj_23_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: A variety of nonvenereal diseases can affect the penis and diminish quality of life. Many present similar clinical features and a cutaneous biopsy may be necessary to clarify the diagnosis. Aims: To characterize nonvenereal penile dermatoses with histological confirmation in a southwestern Europe hospital during a 9-year period. Materials and Methods: A retrospective study was conducted. We reviewed all penile biopsies performed between January 1, 2007 and December 31, 2015 and studied the causes of the nonvenereal penile dermatoses. Results: The sample included a total of 108 patients, aged 62.9 (±17.8) years, between 16 years and 96 years of age. Eighteen dermatoses were identified. Inflammatory diseases were present in 65. 7% of patients (71/108) and neoplastic dermatoses in 34. 3% (37/108). Concerning inflammatory dermatoses, the most frequent were Zoon balanitis (27.8%, 30/108), followed by lichen sclerosus (15.7%, 17/108), psoriasis (11.1%, 12/108), and lichen planus (4.6%, 5/108). In patients with psoriasis, 10 had lesions only in the penis, similarly to all patients with lichen planus. The most frequent malignant tumor was squamous cell carcinoma (SCC) (15.7%, 17/108). The most common in-situ tumor was erythroplasia of Queyrat (8.3%, 9/108). A case of basal cell carcinoma (BCC) was found. Kaposi sarcoma and mycosis fungoides on penis were also diagnosed, as an additional form of presentation to their generalized disease. Conclusions: In this study, inflammatory diseases were the most frequently diagnosed dermatoses, while SCC was the most common malignant tumor found. In the majority of psoriasis and lichen planus cases, clinical lesions were only present in the genital area.
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Affiliation(s)
- Ana Marcos-Pinto
- University Clinic of Dermatology, Hospital de Santa Maria, Lisbon, Portugal
| | - Luís Soares-de-Almeida
- University Clinic of Dermatology, Hospital de Santa Maria, Lisbon, Portugal.,Institute of Molecular Medicine, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Borges-Costa
- University Clinic of Dermatology, Hospital de Santa Maria, Lisbon, Portugal.,Institute of Molecular Medicine, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.,Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
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Merola JF, Qureshi A, Husni ME. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther 2018; 31:e12589. [PMID: 29512290 PMCID: PMC6901032 DOI: 10.1111/dth.12589] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/01/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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Abstract
Individuals with cutaneous diseases of the external genitalia often initially present to their primary care provider. When present, these conditions may be associated with considerable physical symptoms and psychological distress. Dermatoses affecting the genitals may be of infectious, inflammatory, or neoplastic cause, and can be processes confined to the genitalia or a manifestation of a more widespread dermatologic condition. This article provides a guide to recognizing and managing common genital dermatoses and when to refer for specialist opinion.
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Affiliation(s)
- Emily Yura
- Department of Urology, Northwestern University, Tarry Building Room 16-703, 300 East Superior Street, Chicago, IL 60611, USA
| | - Sarah Flury
- Department of Urology, Northwestern University, Tarry Building Room 16-703, 300 East Superior Street, Chicago, IL 60611, USA.
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Affiliation(s)
- Brandon Worley
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven J Glassman
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Gottlieb AB, Kirby B, Ryan C, Naegeli AN, Burge R, Potts Bleakman A, Anatchkova MD, Cather J. The Development of the Genital Psoriasis Sexual Frequency Questionnaire (GenPs-SFQ) to Assess the Impact of Genital Psoriasis on Sexual Health. Dermatol Ther (Heidelb) 2017; 8:33-44. [PMID: 29204894 PMCID: PMC5825317 DOI: 10.1007/s13555-017-0212-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Patient-reported outcome measures (PROs) exist for psoriasis but not genital psoriasis (GenPs). Methods This cross-sectional, qualitative study in patients with moderate-to-severe GenPs was conducted to support development of a PRO for measuring the impact of GenPs on sexual activity and to establish content validity. The impacts of GenPs were identified in a literature review. Findings from the literature review were discussed with clinicians, and then patients with GenPs were interviewed. Results From the literature review, 52 articles, 44 abstracts, and 41 clinical trials met predefined search criteria. Of these, 11 concepts emerged as having theoretical support for use as measurable impacts of psoriasis symptoms on patients; these concepts included sexual functioning and general health-related quality of life (HRQoL). These concepts were confirmed and expanded upon by two clinicians who routinely care for patients with GenPs. Interviews were then conducted with GenPs patients (n = 20) to discuss the impact of GenPs on their HRQoL. Eighty percent of patients reported that GenPs impacted sexual frequency. The two-item GenPs Sexual Frequency Questionnaire (GenPs-SFQ) was developed to assess limitations on sexual activity frequency because of GenPs. Cognitive debriefing with an additional 50 patients with GenPs confirmed the utility and understandability of the GenPs-SFQ. Conclusion The GenPs-SFQ may have utility in clinical trials involving GenPs patients and in routine clinical practice. Funding Eli Lilly and Company. Plain Language Summary Plain language summary available for this article. Electronic supplementary material The online version of this article (10.1007/s13555-017-0212-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alice B Gottlieb
- New York Medical College, Metropolitan Hospital, New York, NY, USA.
| | - Brian Kirby
- St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA
- Winkle College of Pharmacy, Pharmacy Practice and Administrative Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Jennifer Cather
- Modern Dermatology, Aesthetics Center Dallas, Dallas, TX, USA
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Gottlieb AB, Kirby B, Ryan C, Naegeli AN, Burge R, Potts Bleakman A, Anatchkova MD, Yosipovitch G. The Development of a Patient-Reported Outcome Measure for Assessment of Genital Psoriasis Symptoms: The Genital Psoriasis Symptoms Scale (GPSS). Dermatol Ther (Heidelb) 2017; 8:45-56. [PMID: 29204893 PMCID: PMC5825318 DOI: 10.1007/s13555-017-0213-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Patient-reported outcome measures (PROs) specific for genital psoriasis (GenPs) have not been described. METHODS In this cross-sectional, qualitative study in patients with moderate-to-severe GenPs, we sought to develop a PRO useful for GenPs symptom assessment. A literature review was performed to identify relevant psoriasis or GenPs symptoms and existing PROs that may be useful in the evaluation of symptom severity in GenPs patients. The literature review findings were discussed with clinicians, and then patients with GenPs. RESULTS Relevant psoriasis or GenPs symptoms from the literature review included itch, pain, scaling, redness/erythema, and stinging/burning. The validity of these symptoms for GenPs and potentially relevant PROs was corroborated by clinical experts. After gap analysis, a draft symptom scale consisting of Numeric Rating Scale (NRS) items was constructed. We then conducted interviews with GenPs patients (n = 20) to support content validity and use of the draft symptom NRS items in routine practice and in clinical trials. Participants identified and confirmed relevant symptoms and evaluated the utility of the draft PRO. A new PRO was developed: the Genital Psoriasis Symptoms Scale (GPSS). Cognitive debriefing and cultural adaptation/translation interviews with a second group of patients confirmed cultural appropriateness of the GPSS. CONCLUSION The GPSS may be useful for assessing symptoms before, during, and after treatment in routine clinical practice and in clinical trials involving patients with GenPs. FUNDING Eli Lilly & Company. Plain language summary available for this article.
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Affiliation(s)
- Alice B Gottlieb
- New York Medical College, Metropolitan Hospital, New York, NY, USA.
| | - Brian Kirby
- St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA.,Winkle College of Pharmacy, Pharmacy Practice and Administrative Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Gil Yosipovitch
- Miller School of Medicine, University of Miami, Miami, FL, USA
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Cather JC, Ryan C, Meeuwis K, Potts Bleakman AJ, Naegeli AN, Edson-Heredia E, Poon JL, Jones C, Wallace AN, Guenther L, Fretzin S. Patients' Perspectives on the Impact of Genital Psoriasis: A Qualitative Study. Dermatol Ther (Heidelb) 2017; 7:447-461. [PMID: 29076000 PMCID: PMC5698203 DOI: 10.1007/s13555-017-0204-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Indexed: 02/08/2023] Open
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. Electronic supplementary material The online version of this article (doi:10.1007/s13555-017-0204-3) contains supplementary material, which is available to authorized users. Background Psoriasis is a skin disease that can cause itchy, raised red patches of skin. Currently, psoriasis cannot be cured but medicines can make the patches smaller or go away completely. The patches can occur anywhere on the body. Sometimes people get them in their genital area. However, people are sensitive about this area and may not tell their doctor. Their doctor may not look or ask either. What We Did We interviewed 20 men and women who had moderate-to-severe genital psoriasis. We asked about their health-related quality of life, including their sex life. What We Learned All 20 people said they had symptoms of itching and discomfort in their genital area. Most people also had symptoms of redness, stinging or burning, pain, and scaling (flaky skin). Most people said symptoms affected their sex life. Sexual activity was less comfortable. People had sexual activity less often. Physical reasons, such as pain, bothered some people. Emotional reasons, such as being embarrassed, bothered other people more. People said the genital psoriasis affected how they felt. For example, it made them stressed, angry, or sad. Genital psoriasis made physical activities such as walking and running more uncomfortable for many people, especially when symptoms “acted up.” Sweating a lot, wearing tight underwear, or working a long day could make symptoms worse too. About half the people spent less time with their family and friends because of their symptoms. People also did things to try to reduce their symptoms. Some people wore loose clothes or soaked in a bathtub every night or after sex. Other people carried cream (to stop the itch) with them all the time. Conclusion Other people may not experience what these 20 people did. However, having genital psoriasis can significantly impact someone’s life. Patients and doctors should talk about it. Electronic supplementary material The online version of this article (doi:10.1007/s13555-017-0204-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Caitriona Ryan
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Kim Meeuwis
- Departments of Dermatology and Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - April N Naegeli
- Lilly Research Laboratory, Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Cate Jones
- Lilly Research Laboratory, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Lyn Guenther
- The Guenther Dermatology Research Centre, London, ON, Canada
| | - Scott Fretzin
- Dawes Fretzin Dermatology Group, Indianapolis, IN, USA
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