Disclosing the Overall and Sex-Related Disease Burden and Treatment Needs of Patients With Anogenital Psoriasis: Results From the Case-Control PsoGen Study.

PURPOSE: Psoriasis lesions in the anogenital area affect about 33%-63% of the patients at some point in the disease course. Diminished quality of life (QoL), high depression rates, and sexual impairments have been described among patients with anogenital psoriasis, but specific treatment needs of these patients are often neglected in routine healthcare. This study aimed to compare patients with vs. without current anogenital lesions in terms of their sociodemographic and clinical characteristics, patient-reported outcomes (PROs) of disease burden, and patient-defined treatment needs/benefits and to identify clinical variables associated with PROs of disease burden. PATIENTS AND METHODS: The study had a cross-sectional case-control design. Patients aged ≥ 18 years with psoriasis were consecutively recruited in four German dermatology centers and were assigned to case or control group based on both patients' and physicians' reports of current anogenital involvement. PROs included the assessment of QoL impairments, treatment needs/benefits, depression/anxiety, perceived stigmatization, sexual frequency, and relationship/sexual impairments. Physicians assessed the severity of psoriasis and anogenital lesions (PASI and sPGA-G). RESULTS: Participants were 294 patients with psoriasis, of which 159 (54.1%) had current anogenital lesions. Patients with anogenital lesions had higher disease severity, more comorbidities, but were less often treated with biologics. They also reported more QoL impairments, less treatment benefits, poorer mental health, and more sexual impairments. Specific treatment needs of patients with anogenital psoriasis were related to reducing physical and relationship/sexual impairments. Poorer PROs were explained at 25%-68% by higher disease severity, anogenital lesions, no biologic treatment, higher intensity of itching/burning, and lower frequency and more limitations in sexual activity. CONCLUSION: Within a patient-centered approach to dermatology care for psoriasis, clinical decisions, particularly patients' qualification for treatment with biologic drugs, should consider not only the location, extent, and severity of psoriasis lesions but also patient-reported symptoms, overall disease burden, and sexual limitations.