High prevalence of erectile dysfunction in men with psoriasis: evidence from a systematic review and meta-analysis

Abstract

Psoriasis is a common skin disease with the global prevalence of about 2%. Mounting evidence has emerged indicating that there was an association between psoriasis and increased susceptibility to erectile dysfunction (ED). We aimed to assess whether psoriasis was a risk factor for ED through a comprehensive literature review and meta-analysis. The MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched for all studies investigating the erectile function in psoriatic patients. The association between psoriasis and risk of ED was summarized using the odds ratios (OR) with a 95% confidence interval (CI). The protocol for this meta-analysis is available from PROSPERO (CRD42018093025). Overall, 1829449 participants (the mean age ranged from 44 years to 56.3 years) were included from 8 studies (6 cross-sectional, 1 cohort, and 1 case-control study); 39490 of whom were patients with psoriasis, with the mean disease duration from 6 months to 19.9 years. The methodological quality of the 8 included studies was considered to be either moderate or high quality. Synthesis results from the included studies revealed that psoriasis was significantly associated with an increased risk of ED in psoriatic patients (OR = 1.62, 95%CI: 1.37–1.91, P < 0.001; heterogeneity: I2 = 62.6%, P = 0.009). The results were consistent after multivariable adjustment (6 studies; combined OR = 1.5, 95%CI: 1.31–1.72, P < 0.001; heterogeneity: I2 = 53.5%, P = 0.056). Evidence from this meta-analysis indicates that patients with psoriasis have a significantly elevated risk of ED.

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References

  1. 1.

    Boehncke WH, Schon MP. Psoriasis. Lancet. 2015;386:983–94.

    CAS  Article  Google Scholar 

  2. 2.

    Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133:377–85.

    CAS  Article  Google Scholar 

  3. 3.

    Lockshin B, Balagula Y, Merola JF. Interleukin 17, inflammation, and cardiovascular risk in patients with psoriasis. J Am Acad Dermatol. 2018;79:345–52.

    CAS  Article  Google Scholar 

  4. 4.

    Fernandez-Armenteros JM, Gomez-Arbones X, Buti-Soler M, Betriu-Bars A, Sanmartin-Novell V, Ortega-Bravo M, et al. Psoriasis, metabolic syndrome and cardiovascular risk factors. A population-based study. J Eur Acad Dermatol Venereol. 2018. https://doi.org/10.1111/jdv.15159.

  5. 5.

    Gisondi P, Barba E, Girolomoni G. Non-alcoholic fatty liver disease fibrosis score in patients with psoriasis. J Eur Acad Dermatol Venereol. 2016;30:282–7.

    CAS  Article  Google Scholar 

  6. 6.

    Egeberg A, Mallbris L, Warren RB, Bachelez H, Gislason GH, Hansen PR, et al. Association between psoriasis and inflammatory bowel disease: a danish nationwide cohort study. Br J Dermatol. 2016;175:487–92.

    CAS  Article  Google Scholar 

  7. 7.

    Jensen P, Egeberg A, Gislason G, Thyssen JP, Skov L. Risk of uncommon cancers in patients with psoriasis: a danish nationwide cohort study. J Eur Acad Dermatol Venereol. 2018;32:601–5.

    CAS  Article  Google Scholar 

  8. 8.

    Turel EA, Temeltas G, Deveci A, Dinc G, Guler HB, Ozturkcan S. Sexual dysfunction in patients with psoriasis. J Dermatol. 2006;33:772–8.

    Article  Google Scholar 

  9. 9.

    Parisi R, Webb RT, Kleyn CE, Carr MJ, Kapur N, Griffiths C, et al. Psychiatric morbidity and suicidal behaviour in psoriasis: a primary care cohort study. Br J Dermatol 2018. https://doi.org/10.1111/bjd.17004.

  10. 10.

    Nazik H, Nazik S, Gul FC. Body image, self-esteem, and quality of life in patients with psoriasis. Indian Dermatol Online J. 2017;8:343–6.

    Article  Google Scholar 

  11. 11.

    Pompili M, Innamorati M, Trovarelli S, Narci si A, Bellini S, Orsini D, et al. Suicide risk and psychiatric comorbidity in patients with psoriasis. J Int Med Res. 2016;44(1 suppl):61–66.

    Article  Google Scholar 

  12. 12.

    Molina-Leyva A, Almodovar-Real A, Carrascosa JC, Molina-Leyva I, Naranjo-Sintes R, Jimenez-Moleon JJ. Distribution pattern of psoriasis, anxiety and depression as possible causes of sexual dysfunction in patients with moderate to severe psoriasis. Bras Dermatol. 2015;90:338–45.

    Article  Google Scholar 

  13. 13.

    Maaty AS, Gomaa AH, Mohammed GF, Youssef IM, Eyada MM. Assessment of female sexual function in patients with psoriasis. J Sex Med. 2013;10:1545–8.

    Article  Google Scholar 

  14. 14.

    Chung SD, Keller JJ, Chu TW, Lin HC. Psoriasis and the risk of erectile dysfunction: a population-based case-control study. J Sex Med. 2012;9:130–5.

    Article  Google Scholar 

  15. 15.

    Ferreira BR, Pio-Abreu JL, Reis JP, Figueiredo A. Analysis of the prevalence of mental disorders in psoriasis: the relevance of psychiatric assessment in dermatology. Psychiatr Danub. 2017;29:401–6.

    Article  Google Scholar 

  16. 16.

    Meeuwis KA, de Hullu JA, van de Nieuwenhof HP, Evers AW, Massuger LF, van de Kerkhof PC, et al. Quality of life and sexual health in patients with genital psoriasis. Br J Dermatol. 2011;164:1247–55.

    CAS  Article  Google Scholar 

  17. 17.

    Saad F, Haider A, Gooren L. Hypogonadal men with psoriasis benefit from long-term testosterone replacement therapy—a series of 15 case reports. Andrologia. 2016;48:341–6.

    CAS  Article  Google Scholar 

  18. 18.

    Goulding JM, Price CL, Defty CL, Hulangamuwa CS, Bader E, Ahmed I. Erectile dysfunction in patients with psoriasis: increased prevalence, an unmet need, and a chance to intervene. Br J Dermatol. 2011;164:103–9.

    CAS  Article  Google Scholar 

  19. 19.

    Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira EJ, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7:1598–607.

    Article  Google Scholar 

  20. 20.

    Chen YJ, Chen CC, Lin MW, Chen TJ, Li CY, Hwang CY, et al. Increased risk of sexual dysfunction in male patients with psoriasis: a nationwide population-based follow-up study. J Sex Med. 2013;10:1212–8.

    Article  Google Scholar 

  21. 21.

    Cabete J, Torres T, Vilarinho T, Ferreira A, Selores M. Erectile dysfunction in psoriasis patients. Eur J Dermatol. 2014;24:482–6.

    Google Scholar 

  22. 22.

    Tasliyurt T, Bilir Y, Sahin S, Seckin HY, Kaya SU, Sivgin H, et al. Erectile dysfunction in patients with psoriasis: potential impact of the metabolic syndrome. Eur Rev Med Pharmacol Sci. 2014;18:581–6.

    CAS  Google Scholar 

  23. 23.

    Bardazzi F, Odorici G, Ferrara F, Magnano M, Balestri R, Patrizi A. Sex and the PASI: patients affected by a mild form of psoriasis are more predisposed to have a more severe form of erectile dysfunction. J Eur Acad Dermatol Venereol. 2016;30:1342–8.

    CAS  Article  Google Scholar 

  24. 24.

    Ji S, Zang Z, Ma H, Gu M, Han Y, Wang L, et al. Erectile dysfunction in patients with plaque psoriasis: the relation of depression and cardiovascular factors. Int J Impot Res. 2016;28:96–100.

    CAS  Article  Google Scholar 

  25. 25.

    Molina-Leyva A, Molina-Leyva I, Almodovar-Real A, Ruiz-Carrascosa JC, Naranjo-Sintes R, Jimenez-Moleon JJ. Prevalence and associated factors of erectile dysfunction in patients with moderate to severe psoriasis and healthy population: a comparative study considering physical and psychological factors. Arch Sex Behav. 2016;45:2047–55.

    Article  Google Scholar 

  26. 26.

    Egeberg A, Hansen PR, Gislason GH, Skov L, Thyssen JP. Erectile dysfunction in male adults with atopic dermatitis and psoriasis. J Sex Med. 2017;14:380–6.

    Article  Google Scholar 

  27. 27.

    Wu T, Duan X, Chen S, Chen X, Yu R, Yu X. Association between psoriasis and erectile dysfunction: a meta-analysis. J Sex Med. 2018;15:839–47.

    Article  Google Scholar 

  28. 28.

    Molina-Leyva A, Almodovar-Real A, Ruiz-Carrascosa JC, Naranjo-Sintes R, Serrano-Ortega S, Jimenez-Moleon JJ. Distribution pattern of psoriasis affects sexual function in moderate to severe psoriasis: a prospective case series study. J Sex Med. 2014;11:2882–9.

    Article  Google Scholar 

  29. 29.

    Althof SE, Needle RB. Psychological factors associated with male sexual dysfunction: screening and treatment for the urologist. Urol Clin North Am. 2011;38:141–6.

    Article  Google Scholar 

  30. 30.

    Hackett G, Kirby M, Wylie K, Heald A, Ossei-Gerning N, Edwards D, et al. British society for sexual medicine guidelines on the management of erectile dysfunction in men-2017. J Sex Med. 2018;15:430–57.

    Article  Google Scholar 

  31. 31.

    Juan CK, Chen HJ, Shen JL, Kao CH. Lichen simplex chronicus associated with erectile dysfunction: a population-based retrospective cohort study. PLoS ONE. 2015;10:e128869.

    Google Scholar 

  32. 32.

    Chung SD, Keller JJ, Lin HC. Association of erectile dysfunction with atopic dermatitis: a population-based case-control study. J Sex Med. 2012;9:679–85.

    Article  Google Scholar 

  33. 33.

    Heseltine GF. The site of onset of eczema and personality trait differences: an exploratory study. J Psychosom Res. 1963;7:241–6.

    CAS  Article  Google Scholar 

  34. 34.

    Schmitt J, Wozel G. The psoriasis area and severity index is the adequate criterion to define severity in chronic plaque-type psoriasis. Dermatology. 2005;210:194–9.

    Article  Google Scholar 

  35. 35.

    Rosen RC, Cappelleri JC, Gendrano NR. The international index of erectile function (iief): a state-of-the-science review. Int J Impot Res. 2002;14:226–44.

    CAS  Article  Google Scholar 

  36. 36.

    Miller IM, Ellervik C, Yazdanyar S, Jemec GB. Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors. J Am Acad Dermatol. 2013;69:1014–24.

    Article  Google Scholar 

  37. 37.

    Brandrup F, Green A. The prevalence of psoriasis in Denmark. Acta Derm Venereol. 1981;61:344–6.

    CAS  Google Scholar 

  38. 38.

    Bo K, Thoresen M, Dalgard F. Smokers report more psoriasis, but not atopic dermatitis or hand eczema: results from a Norwegian population survey among adults. Dermatology. 2008;216:40–45.

    Article  Google Scholar 

  39. 39.

    Naldi L, Colombo P, Placchesi EB, Piccitto R, Chatenoud L, La Vecchia C. Study design and preliminary results from the pilot phase of the PraKtis study: self-reported diagnoses of selected skin diseases in a representative sample of the Italian population. Dermatology. 2004;208:38–42.

    Article  Google Scholar 

  40. 40.

    Wolkenstein P, Revuz J, Roujeau JC, Bonnelye G, Grob JJ, Bastuji-Garin S. Psoriasis in France and associated risk factors: results of a case-control study based on a large community survey. Dermatology. 2009;218:103–9.

    CAS  Article  Google Scholar 

  41. 41.

    Farber EM, Nall L. Psoriasis in the tropics. Epidemiol, Genet, Clin, Ther Asp Dermatol Clin. 1994;12:805–16.

    CAS  Google Scholar 

  42. 42.

    Chang YT, Chen TJ, Liu PC, Chen YC, Chen YJ, Huang YL, et al. Epidemiological study of psoriasis in the national health insurance database in Taiwan. Acta Derm Venereol. 2009;89:262–6.

    Article  Google Scholar 

  43. 43.

    Molina-Leyva A, Jimenez-Moleon JJ, Naranjo-Sintes R, Ruiz-Carrascosa JC. Sexual dysfunction in psoriasis: a systematic review. J Eur Acad Dermatol Venereol. 2015;29:649–55.

    CAS  Article  Google Scholar 

  44. 44.

    Martyn-Simmons CL, Ranawaka RR, Chowienczyk P, Crook MA, Marber MS, Smith CH, et al. A prospective case-controlled cohort study of endothelial function in patients with moderate to severe psoriasis. Br J Dermatol. 2011;164:26–32.

    CAS  Article  Google Scholar 

  45. 45.

    Kostis JB, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett AL, et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol. 2005;96(12B):85M–93M.

    Article  Google Scholar 

  46. 46.

    Gao L, Zhao Z, Guo F, Liu Y, Guo J, Zhao Y, et al. Association of endothelial nitric oxide synthase polymorphisms with an increased risk of erectile dysfunction. Asian J Androl. 2017;19:330–7.

    CAS  Article  Google Scholar 

  47. 47.

    Rodriguez-Zuniga M, Garcia-Perdomo HA. Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome. J Am Acad Dermatol. 2017;77:657–66.

    Article  Google Scholar 

  48. 48.

    Besiroglu H, Otunctemur A, Ozbek E. The relationship between metabolic syndrome, its components, and erectile dysfunction: a systematic review and a meta-analysis of observational studies. J Sex Med. 2015;12:1309–18.

    CAS  Article  Google Scholar 

  49. 49.

    Maseroli E, Corona G, Rastrelli G, Lotti F, Cipriani S, Forti G, et al. Prevalence of endocrine and metabolic disorders in subjects with erectile dysfunction: a comparative study. J Sex Med. 2015;12:956–65.

    Article  Google Scholar 

  50. 50.

    Creager MA, Luscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Circulation. 2003;108:1527–32.

    Article  Google Scholar 

  51. 51.

    De Simone C, Di Giorgio A, Sisto T, Carbone A, Ghitti F, Tondi P, et al. Endothelial dysfunction in psoriasis patients: cross-sectional case-control study. Eur J Dermatol. 2011;21:510–4.

    Google Scholar 

  52. 52.

    Kadam DP, Suryakar AN, Ankush RD, Kadam CY, Deshpande KH. Role of oxidative stress in various stages of psoriasis. Indian J Clin Biochem. 2010;25:388–92.

    CAS  Article  Google Scholar 

  53. 53.

    Zindanci I, Albayrak O, Kavala M, Kocaturk E, Can B, Sudogan S, et al. Prevalence of metabolic syndrome in patients with psoriasis. ScientificWorldJournal. 2012;2012:312463.

    Article  Google Scholar 

  54. 54.

    Mercan S, Altunay IK, Demir B, Akpinar A, Kayaoglu S. Sexual dysfunctions in patients with neurodermatitis and psoriasis. J Sex Marital Ther. 2008;34:160–8.

    Article  Google Scholar 

  55. 55.

    Kurizky PS, Mota LM. Sexual dysfunction in patients with psoriasis and psoriatic arthritis-a systematic review. Rev Bras Reumatol. 2012;52:943–8.

    Article  Google Scholar 

  56. 56.

    Wylie G, Evans CD, Gupta G. Reduced libido and erectile dysfunction: rarely reported side-effects of methotrexate. Clin Exp Dermatol. 2009;34:e234.

    CAS  Article  Google Scholar 

  57. 57.

    Reynolds OD. Erectile dysfunction in etretinate treatment. Arch Dermatol. 1991;127:425–6.

    CAS  Article  Google Scholar 

  58. 58.

    Aguirre MA, Velez A, Romero M, Collantes E. Gynecomastia and sexual impotence associated with methotrexate treatment. J Rheumatol. 2002;29:1793–4.

    Google Scholar 

  59. 59.

    Cohen-Barak E, Sah M, Kerner M, Rozenman D, Ziv M. Impact of antipsoriatic therapy on endothelial function. Br J Dermatol. 2015;173:1440–6.

    CAS  Article  Google Scholar 

  60. 60.

    Guenther L, Han C, Szapary P, Poulin Y, Bourcier M, Ortonne JP, et al. Impact of ustekinumab on health-related quality of life and sexual difficulties associated with psoriasis: results from two phase III clinical trials. J Eur Acad Dermatol Venereol. 2011;25:851–7.

    CAS  Article  Google Scholar 

  61. 61.

    Ruiz-Villaverde R, Sanchez-Cano D, Rodrigo JR, Gutierrez CV. Pilot study of sexual dysfunction in patients with psoriasis: influence of biologic therapy. Indian J Dermatol. 2011;56:694–9.

    Article  Google Scholar 

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Acknowledgements

This work was supported by the grants from Science and Technology Planning Project of Guangdong Province (No.2017B030314108).

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Correspondence to Zhigang Zhao.

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Zhao, S., Wang, J., Xie, Q. et al. High prevalence of erectile dysfunction in men with psoriasis: evidence from a systematic review and meta-analysis. Int J Impot Res 31, 74–84 (2019). https://doi.org/10.1038/s41443-018-0093-8

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