Erectile Dysfunction in Patients with Psoriasis: Increased Prevalence, an Unmet Need, and a Chance to Intervene

Increased Prevalence, an Unmet Need, and a Chance to Intervene

J.M.R. Goulding; C.L. Price; C.L. Defty; C.S. Hulangamuwa; E. Bader; I. Ahmed

Disclosures

The British Journal of Dermatology. 2011;164(1):103-109. 

In This Article

Abstract and Introduction

Abstract

Background Male erectile dysfunction (ED) is common, frequently caused by pelvic arterial atherosclerosis, and is a predictor of future cardiovascular disease. There is an emerging association between psoriasis, the metabolic syndrome and atherosclerotic disease. We hypothesized that ED occurs more commonly in patients with psoriasis, at least in part due to incipient atherosclerosis, which may offer an opportunity for early intervention.
Objectives To determine the prevalence of, and risk factors for, ED in patients with psoriasis in comparison with a heterogeneous dermatology outpatient control group.
Methods We conducted a pilot study with a prospective observational cross-sectional design, recruiting consecutive adult male dermatology outpatients diagnosed with psoriasis or any other skin condition. Sexually active participants completed a questionnaire, a Dermatology Life Quality Index and the validated five-item version of the International Index of Erectile Function (IIEF-5).
Results Fifty-three of 92 (58%) patients with psoriasis recorded an IIEF-5 score indicative of ED, compared with 64 of 130 (49%) control patients, reflecting an age-adjusted odds ratio of 2·007 (95% confidence interval 1·088–3·701; P = 0·026). A multivariable logistic regression model indicated that increasing age and hypertension, but not a diagnosis of psoriasis, were independent risk factors for ED in our study population.
Conclusions We present the largest survey of ED in patients with skin disease, and the first to posit the potential link between psoriasis, ED and atherosclerosis. We suggest that an assessment of sexual function should be part of the routine holistic care provided for dermatology outpatients, and highlight the need to screen for cardiovascular risk factors in those with documented ED.

Introduction

Psoriasis is a chronic inflammatory skin disease with an estimated prevalence of 1·5% in the U.K.[1] It is well recognized that psoriasis may have a markedly deleterious effect on patients' quality of life, with the physical, social and psychological impact comparable with that seen in heart disease, diabetes mellitus and cancer.[2] The burden on patients' partners and the wider family is also significant.[3] Very few data exist regarding the influence of psoriasis on patients' sexual functioning, although it has been demonstrated that this crucial aspect of life may also be impaired, in both sexes.[4–7]

Male erectile dysfunction (ED) has been defined as the persistent inability to attain and/or maintain an erection sufficient for sexual performance.[8] ED is very common, and prevalence as well as severity increases with age.[9] It is recognized that a major cause of ED is atherosclerosis affecting the pelvic vasculature.[10] The presence of ED is known to predict future cardiovascular disease, and early detection may allow timely modification of remediable risk factors, or lead to the diagnosis of occult cardiovascular disease.[11,12] There is an emerging association between psoriasis, the metabolic syndrome and atherosclerotic disease, with increased rates of myocardial infarction and stroke seen in patients with psoriasis.[13–17] We hypothesized that ED occurs more commonly in patients with psoriasis, at least in part due to incipient atherosclerosis, which may offer an opportunity for early intervention. We sought to investigate the prevalence of ED in patients with psoriasis compared with those with other skin conditions, and to explore any association with risk factors for atherosclerotic disease.

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