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Dr Maiana Larsabal First author, resident

“GENIPSO”: a French prospective study assessing instantaneous prevalence, clinical features and impact on quality of life of genital psoriasis among patients consulting for psoriasis.

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Dr Maiana Larsabal First author, resident

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  1. “GENIPSO”: a French prospective study assessing instantaneous prevalence, clinical features and impact on quality of life of genital psoriasis among patients consulting for psoriasis M. Larsabal1,S. Ly1,2,3,E. Sbidian3,4,5,M. Moyal-Barracco2,6,J-N Dauendorffer2,3,7,N.Dupin6,8,MA. Richard3,9,O. Chosidow3,4,5,8,M. Beylot-Barry1,3 Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France Vulvology Study Group of the French Society for Dermatology Psoriasis Research Group of the French Society for Dermatology Department of Dermatology, Henri-Mondor Hospital, Public Assistance – Paris Hospitals(AP-HP), Paris-Est University Créteil (UPEC), Créteil, France Paris-Est University, UPEC, Virus, Immunity and Cancer University-Hospital Complex (DHU VIC), EA 7379 Epidemiology in Dermatology and Evaluation of Treatments(EpiDermE), F-94000 Créteil, France Department of Dermatology, Cochin Tarnier Hospital, Paris Descartes University, Paris, France Department of Dermatology, Saint-Louis Hospital, Paris, France Dermatological Infectiologyand Sexually Transmitted Diseases Group of the French Societyfor Dermatology DepartmentofDermatology, TimoneHospital, Public Assistance–MarseilleHospitals,Marseille, France Aix-Marseille University, UMR 911, INSERM CRO2, “Centre de recherche en oncologie biologique et oncopharmacologie” British Journal of Dermatology. DOI: 10.111/bjd.17147

  2. Dr MaianaLarsabal First author, resident Dr Sandra Ly Principal investigator Pr Marie Beylot-Barry Co-principal investigator Corresponding author

  3. Introduction What’s already known? • Genital psoriasis is frequent but under recognised • Its reported prevalence varies widely from 12% to 38% owing to different methods of evaluating prevalence • Prevalence is likely to be underestimated because patients and doctors’ are reluctant to discuss genital involvement and sexual quality of life • It can be disabling and difficult-to-treat

  4. Objectives • Primary objective : • To determine the instantaneous prevalence of genital psoriasis in patients consulting for extra-genital psoriasis • Secondary objectives: • To describe the clinical features of genital psoriasis • To determine whether genital involvement was associated with a particular psoriasis phenotype • To assess the impact of genital involvement on overall and sexual quality of life

  5. Methods (1) • Observational, prospective, cross-sectional, multicentre study conducted in France between November 2016 and March 2017 Funding from : 78 dermatologists 24 Privatepractive 19 General hospitals 35 Universityhospitals On behalf of the study groups :

  6. Methods (2) • Pre-inclusion training of investigators • Using an online tutorial specificallydesigned for the study • Inclusion criteria: • Consecutive patients at least 18 years old, consulting a dermatologist for extra-genital psoriasis M Moyal-Barracco JN Dauendorffer et N Dupin

  7. Methods (3)

  8. Results (1) Acceptance rate : 85% Prevalence of genitalinvolvement : 43.2%; CI95% [39.7-46.7] All patients withgenitallesionswereaware of them Only 135 (40%) hadalreadyhad an examination of the genital area by a dermatologist Identicalprevalence in private practice and in hospitals *Informedwrittenconsent

  9. Results (2) Genital and perigenital anatomical sites Erythematous-squamous 40% (128/318) Fissures 26% (88/335) Erythematous 45% (143/318) Squamous 15% (47/318) 72% of patients had at least one functionalsymptom: Itching Dyspareunia Burning sensation Hairless skin -Women. Vulva: Labia minora, labia majora (inner side), anterior commissure, interlabial groove -Men. Penis : Glans, foreskin (inner side) Hair-bearing skin -Women: Mons pubis, labia majora (external side), perineum -Men: Pubis, shaft, foreskin (external side), scrotum, perineum Perigenital skin Inguinal folds, anal margin, gluteal cleft

  10. Results (3) Characteristicsassociatedwithgenital psoriasis (multivariateanalysis) • Quality of life, anxiety depression and sexual-life evaluation (401/776 questionnaires returned) DLQI: Dermatology Life Quality Index; HADS: Hospital Anxiety Depression Scale; FSFI: Female Sexual Function Index; IIEF: International Index of Erectile Function

  11. Discussion (1) • A high prevalence (43.2%) of genital psoriasis • In a “real-life” representative population of psoriatic patients • Similar prevalence in private practice compared to hospital based settings • Informative data for clinical description (optimization due to online tutorial=> a tool easy to use for educative applications) • Risk factors associated with genital lesions : • Male gender, severity of psoriasis, age of onset between 20 and 60 years, inverse psoriasis, scalp, nail and external auditory canal involvement • But not high body mass index or psoriatic arthritis

  12. Discussion (2) High patient participation rate (85%) • Reflects a real need in patients to have genital lesions considered. • While only 40% of patients with genital lesions declared to have already undergone genital examination by a dermatologist. • Dermatologists should question their own practice and not hesitate to suggest patients consulting for psoriasis undergo a genital examination. Genital psoriasis is associated with symptoms (itching++) and negative impact on overall quality of life

  13. Discussion (3) • Almost all patients included had ongoing treatment • The study was not designed to evaluate treatment efficacy, but this reinforces the conclusion that genital examination should be considered even in patients treated with systemic conventional or biologic treatments.

  14. ConclusionsWhat does this study add? • Instantaneous prevalence of genital psoriasis in patients consulting for extra-genital psoriasis was 43.2% • Only 40% of patients with genital psoriasis declared having had a previous examination of the genital area by a dermatologist. • Due to its frequency and impact on general and sexual quality of life, genital psoriasis should be screened in all patients, regardless of the PASI score, or ongoing treatment for psoriasis

  15. The research team Jean-Noel Dauendorffer Micheline Moyal-Barracco Emilie Sbidian Sandra Ly MaïanaLarsabal Nicolas Dupin Marie-Aleth Richard Christine Alfaro as studycoordonator Léo Barry for drawing figures Laurent Elgard for technical support (on-line tutorial) Marie Beylot-Barry Olivier Chosidow

  16. We thank all investigators for participating in the GENIPSO study: ABDO Ivana, ACQUITTER Marie, AMI DE LA BRETEQUE MIGNOT Maud, AMICI Jean-Michel, ARCHIER Elodie, AUBIN François, BARTHELEMY Hugues, BAUBION Emilie, BENETON Nathalie, BOLAC Cécile, BOUILLY Danielle, BOURSEAU-QUETIER Catherine, BRENAUT Emilie, BUZENET Christel, CAMUS Magalie, CELERIER Philippe, CHABBERT Cécile, CHAMAILLARD Mélanie, CHARLES Sophie, DARRIGADE Anne-Sophie, DELARUE Michele-Pillette, DEPAIRE Florence, DEVAUX Suzanne, DO-PHAM Giao, DUVAL-MODESTE Anne-Benedicte, FABRE Françoise, FAUCONNEAU Antoine,FITE Charlotte, FLEURET Camille,GIRARD Céline, GRANDE Sophie, GUILLET Stéphanie, HACARD Florence,HEGAZYSalama, HOSTEING Stéphanie,JACQUIN Marie-Agnès, JEGOU Marie-Hélène, JOLY Pascal, JOUARY Thomas, JULIEN Denis, KEMULA Mathilde, KOSTRZEWA Elise, LACOUR Jean-Philippe, LEGRAIN Valérie, LIVIDEANU Cristina, LU Devy, MACCARI François, MAGNE Françoise, MARTIN Clemmie, MEUNIER Laurent, MISERY Laurent, PARIER Josiane, PELLETIER Fabien, PERRUSSEL Marc, PETIT-FAUCONNEAU Antoine, PEYROT Itzia,PLANTIN Patrice, PRUVOST-BALLAND Christelle, REGNIER Elodie, REYNIER-REZZI Judith, SALZES Camille, SENESCHAL Julien, SHOLLHAMMER Martine, SOUTEYRAND Agathe,STAUMONT Delphine, TOULEMONDE Anne, VANHAECKE Clelia, VEDIE Anne-Laure, VERSAPUECH Julie,VIGANMartine,VIGUIER Manuelle, VILLANI Axel. We thank all the patients who participated in this study. And for funding :

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