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Patients with Intertriginous Area Psoriasis Frequently Report Embarrassment, Sexual Distress

Online survey results show adults with psoriasis in specific areas may be treating and monitoring disease without clinician guidance—sometimes out of embarassment.

Approximately two-thirds of patients with plaque psoriasis have reported symptoms impacting them in burdensome, difficult-to-treat intertriginous areas of the skin, according to findings from a new survey.

The result is a pattern of psychosocial, sexual and mental health impact on such affected patients, who additionally expressed a desire for single-therapy options to treat intertriginous psoriasis going forward.

In new data presented at the Society of Dermatology Physician Assistants (SDPA) 2022 Annual Meeting this week, a team of US investigators supported by Arcutis Biotherapeutics presented findings from an online survey showing adult patients with psoriasis generally agree with the notion that disease in intertriginous areas including the groin, beneath stomach and breast folds, in the armpit and between the buttocks, negatively impact their quality of life in a multitude of ways.

Led by Teri Greiling, MD, PhD, associate program director of research and dermatology at the Oregon Health & Science University School of Medicine, investigators conducted an analysis of a 2021 online Harris Poll including American adults with plaque psoriasis treated with topical therapy. More specifically, their assessment focused on the subset of patients with psoriasis involvement in intertriginous areas.

Mean patient age was 45.1 years; 44.0% of patients were women. Patients generally had moderate psoriasis (67%), with 70% preferring topical therapy and each patient averaging 2.6 prescription topical drugs, 2.3 over-the-counter drugs, and 0.9 prescription oral drugs.

Of the 507 survey respondents, 320 (64%) reported psoriasis symptoms in intertriginous areas during the disease course; the most commonly affected areas were between the buttocks and armpits. Awareness of disease impact was a prevalent issue; 40% of patients with psoriasis intertriginous area involvement did not report being impacted by such disease until after seeing pictures of psoriasis in these areas.

Patients with psoriasis in intetriginous areas commonly reported a sense of embarrassment (80%), anxiety (79%) or depression (69%) relevant to their disease. These patients also frequently reported their specific disease having a strong or very strong negative impact on sexual distress or anxiety (45%), intimate relationships (39%) and sexual function (37%). Each of these components were even more common among patients with groin involvement psoriasis.

Nearly all patients with intertriginous area psoriasis reported an effect on their overall quality of life (97%). Symptoms commonly driving negative effects on patient quality of life included itching (61%), scaling (53%) and redness (49%).

These patients were also infrequently including health care providers in their disease status; despite psoriasis between the buttocks being the most frequent form of intertriginous area psoriasis (47%), only 1 in 5 affected patients (19%) showed this body area to their clinician.

“Typical protocols for (health care provider) visits seem to range from some patients disrobing, whereas others remained fully clothed,” investigators wrote.

Approximately half (52%) of patients reported having to use different topical treatments to treat different locations of their disease. Another 43% reported using topical treatments on areas of their skin without discussing it with a clinician. Nearly 9 in every 10 patients stated they would both prefer a single-treatment option for their psoriasis, and anticipate they would be more adherent to treatment if such an option was available.

Overall, Greiling and colleagues noted significant trends in patient burdens when managing intertriginous area psoriasis, some of which may be mitigated with improved communication with clinicians and bolstered treatment options for their specific state of disease.

“Almost 2 in 3 patients with psoriasis reported symptoms in intertriginous areas at some point in the course of their disease,” investigators wrote. “Psoriasis in intertriginous areas has a negative impact on patients’ lives, particularly their emotional well-being and their sexual health.”

The study, “Patient Perspectives on the Prevalence and Burden of Intertriginous Psoriasis: Results From a National Survey of Adults With Psoriasis in the United States,” was presented at SDPA 2022.