الفهرس 
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Abstract
Psoriasis is a common chronic inflammatory immune mediated disease that affects males and females equally .It is considered a multi-organ disease affecting mainly skin and joints. The most common clinical type of psoriasis is psoriasis vulgaris. Clinically it is characterized by sharply circumscribed, round-oval, or nummular scaly erythematous plaques of variable size, covered with silvery white scales and located mainly on scalp, elbows and knees. Other clinical types include guttate, erythrodermic, pustular, flexural, and arthropathic psoriasis.
Multiple factors are involved in psoriasis pathogenesis including genetic and immunologic factors together with environmental triggers although the exact cause of psoriasis remains unknown.
The pathophysiology of psoriasis is characterized by immune activation and up-regulation of Th1, Th17 cytokines following increased antigen presentation leading to overgrowth of epidermal keratinocytes and the clinical phenotype of the disease.
In the last few years various studies reported that psoriasis had a negative impact on the quality of life. More than a cosmetic nuisance, psoriasis can produce anxiety, depression, sexual dysfunction and other psychological problems that affect patients’ lives in ways comparable to arthritis or other disabling illnesses. The objective of the present study was to evaluate the sexual function of the psoriasis patients and their partners and to compare them to healthy controls.
The present study included 637 subjects divided into three groups, group A included 220 psoriasis patients (110 males and 110 females), group B included consenting patients` partners (98 males and 99 females) and group C included 220 healthy controls (110 males and 110 females).
Exclusion criteria included presence or a history of chronic dermatological diseases other than psoriasis, systemic medication other than NB-UVB within the last three months, systemic cardiovascular disease, cerebrovascular accident or peripheral vascular disease, other chronic diseases such as pulmonary, hepatic, renal, hematological, neurologic, malignancy, endocrinal, metabolic, or psychiatric disorders. Additionally, using antidepressant, diuretics, beta-blockers, and inhibitors of 5-alpha reductase or other drugs that are known to influence erectile function, existence of clinical conditions that could be associated with ED such as surgery, accidents and trauma in the lower abdomen were exclusion criteria in males. Pregnancy, lactation were exclusion criteria in females. Patients with pustular, erythrodermic or arthropathic psoriasis or with previous sexual dysfunction prior to affection by psoriasis were also excluded.
Patients were subjected to history taking and clinical general examination to exclude systemic diseases and dermatological examination to determine the clinical type of psoriasis and PASI score .Blood samples were collected from patients to measure blood sugar and lipid profile. Waist circumference, blood pressure and body mass index were measured for psoriasis patients for assessment for metabolic syndrome.
All participants were required to answer HADS questionnaire to evaluate anxiety and depression, RESQ to evaluate self-esteem, DLQI Q9 for effect of psoriasis on quality of sexual life, both IIEF and IIEF-5 questionnaires (for males only) and FSFI (for females only) to evaluate erectile and sexual function.
Male psoriasis cases who reported erectile dysfunction were evaluated for hormonal (testosterone and prolactin) profile and assessment of penile vascularity by penile duplex ultrasound. Most of them were diagnosed as psychogenic erectile dysfunction.
This study found that psoriasis was significantly associated with higher levels of anxiety, depression, low self-esteem and sexual/erectile dysfunction in both patients and their partners. It caused marital and employment related problems in patients of both genders.
Regarding female participants; the female psoriasis cases were the most affected both psychologically and sexually as compared to female partners and controls, while in male participants; the male partners were the most sexually and psychologically affected.
The psychological burden of the disease was related mostly to the disease duration rather than clinical severity in our cases.
Sexual and erectile dysfunctions were significantly associated with increased PASI score, genital psoriasis, anxiety, depression and low self-esteem in both male and female cases and with metabolic syndrome in female cases.
Regression analysis indicated that genital psoriasis and depression were independent risk factors for sexual dysfunction in both genders, while clinical severity was an additional risk factor in females.
Erectile dysfunction in male cases was found to be mostly of psychogenic origin.
This study concluded that the assessment of sexual function is preferred to be a part of the comprehensive care of psoriasis patients and their partners.