BSV01 Anogenital psoriasis: an inclusive literature review with clinician survey data demonstrating current clinical awareness and practices with subsequent patient-focused feasibility studies for real-world experiences and outcomes

Abstract

Psoriasis affects approximately 2% of the global population, with significant associated medical and psychological comorbidity (Meeuwis KA, de Hullu JA, Massuger LF et al. Genital psoriasis: a systematic literature review on this hidden skin disease. Acta Derm Venereol 2011; 91: 5–11). Anogenital psoriasis occurs in isolation in 2–5% of cases but more commonly coexists with other psoriasis subtypes (29–64%), particularly flexural psoriasis. It is often associated with increased psychosexual burden, especially in women [Beck KM, Yang EJ, Sanchez IM et al. Treatment of genital psoriasis: a systematic review. Dermatol Ther (Heidelb) 2018; 8: 509–25]. The reported prevalence of anogenital psoriasis varies due to heterogeneous studies, variable or absent validated disease outcome measurements, under-recognition, and reluctance of patients and clinicians to discuss genital involvement. This suggests the true burden is likely underestimated, and the condition is undertreated with limited evidence-based physical and psychological management options. A UK-wide clinician survey was carried out to explore real-world practice and perceptions of flexural and genital psoriasis. Patient focus groups were formed to study the acceptability and relevance of current practice. The online clinician survey of 21 questions was circulated to UK dermatologists and dermatology specialist nurses through associated dermatology networks. Ethical approval was obtained for focus groups for patients aged > 18 years, clinically diagnosed with anogenital psoriasis by a dermatologist, with or without any subtype of psoriasis, and on any treatment modality. Patients provided informed consent for participation in virtual interviews. A grant of £9590 was provided by the UK Dermatology Clinical Trials Network for patient participation, future publication and dissemination costs. Clinicians recognized the psychological impact of anogenital psoriasis. The analysis demonstrated barriers to assessment and limited standardization of treatment regimens, despite clinician awareness. Focus group analysis identified nine overarching themes describing the lived experience of anogenital psoriasis, highlighting substantial diagnostic, psychosocial and therapeutic challenges. This novel clinician–patient anogenital psoriasis study highlights the need for robust research, incorporating physical and psychosocial outcomes for holistic evidence-based management and enhanced education to reduce stigma for this high-burden, under-represented condition.