Genital Psoriasis: Clinical Features, Management, and Impact on Quality of Life

Abstract

Genital psoriasis is a chronic inflammatory skin condition that has been reported in up to 63% of patients with psoriasis on other parts of their skin. It has a profound impact on quality of life and sexual function which is overlooked by current severity scores. Despite its prevalence and disease burden, genital psoriasis remains largely under-reported and under-treated. Historically, this has been due to the impracticality and limited efficacy data of standard psoriasis treatments when applied to genital skin. However, there have been recent advancements with several new agents currently being developed and evaluated for genital psoriasis. This thesis aims to provide an overview of the current evidence regarding the clinical features of genital psoriasis, available management options and tools for assessing patients’ quality of life. This thesis also investigates the patterns of care of vulval psoriasis in paediatric and adult population in Australia through a retrospective chart review of a single dermatology referral centre. Lastly, this thesis also examines the quality-of-life impact of adult vulval psoriasis to highlight areas of focus and improvement for clinicians.

Chapter one of this thesis highlights this often-neglected genital involvement of psoriasis and its quality-of-life impact. Additionally, it discusses the current management options for genital psoriasis in adults available in Australia. Chapter two investigates the presentation of vulval psoriasis in adults, looking at their clinical features, topicals and systemic treatments, commenting on the current landscape of Pharmaceutical Benefits Schedule. Chapter three explores the presentation of paediatric vulval psoriasis, exploring its clinical features and management strategies used in Australia. Finally, Chapter 4 presents a summary of the thesis findings, commenting on directions for future research.