Unlike other types of lichen planus (LP), there are no series concerning male genital LP.
To describe the clinical characteristics, diagnosis, and response to treatment of male genital LP.
A ...retrospective study of male patients with genital LP consulting a dermatologist specialized in anogenital diseases between January 2010 and 2019. Demographic data, history, functional signs, clinical characteristics, pathology, complications, and treatment efficacy were collected.
Eighty-nine patients were included at four centers. The median age was 51 years. Most patients were uncircumcised and asymptomatic. In 88.8% of cases, only the genital mucosa was involved. Erythema (71%), papules (21.3%), lacy network (15.7%), atrophic lesions (15.7%), erosions (14.6%), and post-inflammatory hyperpigmentation (2.2%) were less frequently observed. Biopsy results confirmed LP in 61.3% of cases but could not rule out other inflammatory genital dermatoses in other cases. Anatomic complications were observed in 30.3% of patients. Topical corticosteroids (TCS) induced remission in most cases. Tacrolimus efficacy was comparable to that of TCS.
Male genital LP is a rare inflammatory disorder chiefly affecting uncircumcised men. It is found predominantly on the mucosal component of the penis and presents as non-erosive inflammatory balanitis in most cases, with frequent partial or complete remission on treatment with TCS.
Summary
Background Discrepancies between cutaneous specimen sizes reported by the dermatosurgeon and the pathologist are important to evaluate because of their legal implications for malignant ...tumours and the downcoding of surgical acts.
Objectives The objective of this study was to determine the magnitude of changes in size and the factors influencing the retraction of routine skin excision specimens.
Methods Three measurements of 82 skin excision specimens—consisting of length and width of the planned surgical excision (in vivo), length, width and depth of the specimens following excision (ex vivo) and of the specimens after formalin fixation (in vitro)—were performed and compared using a nonparametric paired test. Factors (age, sex, type and location of the lesions and initial measures) that could influence the amount of shrinkage were analysed using multiple linear regression models.
Results The mean in vivo to in vitro shrinkage was 16% for length and 18% for width (P < 0·001). The shrinkage was significant between in vivo and ex vivo measures (P < 0·001), while no difference was observed between ex vivo to in vitro measures. In multivariate analysis, length shrinkage increased significantly with initial length (regression coefficient of 0·24, P = 0·001) and limb location (1·25, P = 0·048), and decreased significantly with initial width (−0·19, P = 0·016). After adjusting for initial width, width shrinkage was neither significantly associated with type of lesion (malignant or not, P = 0·20), nor with location (P = 0·35).
Conclusions Shrinkage of skin excision specimens occurred immediately after surgical excision and prior to formalin fixation. Patients’ age, sex and type of skin lesion did not influence the amount of shrinkage. Length shrinkage was more important for specimens excised from the extremities and increased with initial length and smaller width.
Summary
Background
Genital psoriasis is often under‐recognized.
Objectives
To assess the instantaneous prevalence of genital psoriasis and describe its clinical features, association with a ...particular subtype of psoriasis and its impact on general and sexual quality of life (QoL).
Methods
GENIPSO is a prospective study conducted by private and hospital‐based dermatologists. This study featured the consecutive inclusion of patients consulting for extragenital psoriasis. The clinical features of psoriasis and genital psoriasis were recorded and QoL and sexual health questionnaires were distributed to patients.
Results
Overall, 335 of 776 patients (43·2%) included in the study had genital involvement. All were aware that they had genital lesions but only 135 patients (40%) declared that they had been previously examined. Genital lesions were associated with male sex, severity of psoriasis, age of onset > 20 years, inverse psoriasis and involvement of scalp, nail and external auditory canal, but were not associated with obesity, psoriatic arthritis and active sex life. Itching was the main symptom. Genital psoriasis was associated with impairment of QoL and sexual health according to the Dermatology Life Quality Index and the Female Sexual Function Index.
Conclusions
Genital psoriasis has a high prevalence in patients consulting for extragenital psoriasis, which affects QoL, and should be taken into account by dermatologists in order to optimize global care.
What's already known about this topic?
Genital psoriasis is frequent but under‐recognized.
What does this study add?
The instantaneous prevalence of genital psoriasis in patients consulting for extragenital psoriasis was 43·2%.
All patients were aware of their genital psoriasis but only 40% declared having had a previous examination of the genital area by a dermatologist.
What are the clinical implications of this work?
Owing to its frequency and impact on general and sexual quality of life, genital psoriasis should be screened in all patients, including those already receiving treatment for psoriasis.
Respond to this article
Linked Comment: Ryan. Br J Dermatol 2019; 180:460–461.
Plain language summary available online
Psoriasis and male sexuality Dauendorffer, J-N; Ly, S; Beylot-Barry, M
Annales de dermatologie et de vénéréologie
146, Issue:
4
Journal Article
Peer reviewed
Open access
Since sexual satisfaction is a key factor in quality-of-life scores, the aim of this review article is to examine current knowledge concerning the impact on male sexuality of psoriasis, particularly ...genital psoriasis. Risk factors for sexual dysfunction, and more specifically erectile dysfunction, demonstrated to date include severity of psoriasis, genital psoriasis, psoriatic arthritis, smoking, psychological disorders (anxiety-depression), cardiovascular comorbidities and side effects of psoriasis treatments. Studies evaluating the burden of genital psoriasis on male sexuality are contradictory: while the link between genital psoriasis and global sexual functioning has been clearly established in relation to question 9 of the DLQI, discrepancies exist between the scoring systems used concerning sexual satisfaction. Finally, psoriasis patients have expressed a wish to receive more care from their dermatologist in terms of their genital psoriasis and its impact on their sexual activity.
Background
Epithelial surface disruption in genital psoriatic lesions may manifest as erosions, fissures and/or ulcers, causing pain and significantly impacting a patient's sexual health.
Objective
...To evaluate the impact of erosions, fissures and/or ulcers in genital psoriatic lesions on pain and sexual activity in patients with moderate‐to‐severe genital psoriasis (GenPs) and treatment responses to ixekizumab vs. placebo until Week 12.
Methods
This post hoc subgroup analysis of patients presenting with and without erosions, fissures and/or ulcers in genital lesions from a phase IIIb multicentre, randomized, double‐blind, placebo‐controlled study (IXORA‐Q; NCT02718898) in 149 adults with moderate‐to‐severe GenPs treated with subcutaneous ixekizumab (80 mg every 2 weeks; n = 75) or placebo (n = 74) evaluated outcomes for clinician‐rated GenPs severity (static Physician's Global Assessment of Genitalia; sPGA‐G) and patient‐reported genital pain and itch (Genital Psoriasis Symptoms Scale; GPSS) and sexual health (Genital Psoriasis Sexual Frequency Questionnaire; GenPs‐SFQ).
Results
At baseline, 38% (n = 57) of patients presented with genital erosions, fissures and/or ulcers independent of overall body surface area involvement (<10% or ≥10%). These signs were associated with higher scores for disease severity (sPGA‐G) and pain (GPSS) but not sexual health (GenPs‐SFQ). Complete resolution of these signs was observed in 62% of ixekizumab‐treated patients (25% for placebo) at Week 1 and 83% (21% for placebo) at Week 12. Patients treated with ixekizumab reported significant improvements in pain, itch, disease severity and sexual health over 12 weeks compared to placebo and irrespective of the presence/absence of genital erosions, fissures and/or ulcers at baseline.
Conclusion
Ixekizumab led to rapid and sustained resolution of erosions, fissures and/or ulcers and significant improvements in GenPs severity, genital pain and sexual health. Ixekizumab may help to improve the well‐being of patients with GenPs.
Reactional squamous hyperplasia of the foreskin Dauendorffer, J.N.; Cavelier‐Balloy, B.; Fouéré, S. ...
Journal of the European Academy of Dermatology and Venereology,
October 2020, 2020-Oct, 2020-10-00, 20201001, Volume:
34, Issue:
10
Journal Article
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