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Review
January 2019

Association Between Psoriasis and Sexual and Erectile Dysfunction in Epidemiologic Studies: A Systematic Review

Author Affiliations
  • 1Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
  • 2Dermatología, Hospital Campus de la Salud, Granada, Spain
  • 3Instituto de Investigación Biosanitaria ibs, Granada, Spain
  • 4Departamento de Dermatología, Facultad de Medicina, Universidad de Granada, Granada, Spain
JAMA Dermatol. 2019;155(1):98-106. doi:10.1001/jamadermatol.2018.3442
Key Points

Question  What is the available scientific evidence regarding the associations between psoriasis and sexual and erectile dysfunction in epidemiologic studies?

Findings  In this systematic review of 28 studies, patients with psoriasis were noted to have a greater risk of sexual and erectile dysfunction compared with a healthy population independent of physical and psychological comorbidities. Among patients with psoriasis, those with anxiety, depression, psoriatic arthritis, and genital psoriasis had a higher risk; biologic drug therapy can improve sexual dysfunction.

Meaning  Psoriasis could increase the risk of sexual dysfunction, particularly in patients with psychological comorbidity; treatment should be optimized in patients with sexual dysfunction.

Abstract

Importance  Sexual health is a major aspect of life. Increasing scientific evidence shows a potential association between psoriasis and sexual dysfunction (SD) and erectile dysfunction (ED).

Objective  To evaluate the available scientific evidence regarding epidemiologic associations and treatment outcomes between psoriasis and SD and ED.

Evidence Review  Information sources were MEDLINE and Embase databases, using the Scopus search engine. The search was performed on August 25, 2017. Search terms were psoriasis and sexual or sexual dysfunction, and the search was limited to epidemiologic studies published in English answering any of the 4 research questions. Quality was assessed according to the Centre for Evidence-Based Medicine.

Findings  Twenty-eight studies representing 52 520 cases of psoriasis and 1 806 022 controls were included for review. Of the 28 studies, 19 were cross-sectional, 3 were clinical trials, 3 were quasi-experimental, 2 were population-based cohort, and 1 was population-based case-control. Prevalence of SD and ED ranged from 40.0% to 55.6% and 34.2% to 81.1%, respectively. Two of 2 studies observed an association between psoriasis and SD after adjusting for physical and psychological comorbidities. Five of 8 studies observed an independent association between ED and psoriasis. Among patients with psoriasis, the features that showed the strongest association with SD were anxiety and depression (5 of 5 studies), psoriatic arthritis (3 of 4 studies), and genital psoriasis (5 of 7 studies). Regarding ED, anxiety and depression (2 of 2 studies) and increasing age (3 of 3 studies) showed the strongest association. All 3 clinical trials using biologic drugs showed an improvement in SD compared with placebo.

Conclusions and Relevance  Patients with psoriasis have physical and psychological comorbidities that have been associated with a higher risk of SD. In addition, psoriasis may play a role in its development. The presence of anxiety, depression, psoriatic arthritis, genital lesions, and increasing age should raise the awareness of SD. Biologic drugs have demonstrated the improvement of SD in patients with psoriasis.

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