title: Erectile dysfunction in patients with psoriasis: increased prevalence, an unmet need, and a chance to intervene.
abstract: BACKGROUND
  Male erectile dysfunction (ED) is common, frequently caused by pelvic arterial atherosclerosis, and is a predictor of future cardiovascular disease. There is an emerging association between psoriasis, the metabolic syndrome and atherosclerotic disease. We hypothesized that ED occurs more commonly in patients with psoriasis, at least in part due to incipient atherosclerosis, which may offer an opportunity for early intervention.
  
  
  OBJECTIVE
  To determine the prevalence of, and risk factors for, ED in patients with psoriasis in comparison with a heterogeneous dermatology outpatient control group.
  
  
  METHODS
  We conducted a pilot study with a prospective observational cross-sectional design, recruiting consecutive adult male dermatology outpatients diagnosed with psoriasis or any other skin condition. Sexually active participants completed a questionnaire, a Dermatology Life Quality Index and the validated five-item version of the International Index of Erectile Function (IIEF-5).
  
  
  RESULTS
  Fifty-three of 92 (58%) patients with psoriasis recorded an IIEF-5 score indicative of ED, compared with 64 of 130 (49%) control patients, reflecting an age-adjusted odds ratio of 2·007 (95% confidence interval 1·088-3·701; P = 0·026). A multivariable logistic regression model indicated that increasing age and hypertension, but not a diagnosis of psoriasis, were independent risk factors for ED in our study population.
  
  
  CONCLUSIONS
  We present the largest survey of ED in patients with skin disease, and the first to posit the potential link between psoriasis, ED and atherosclerosis. We suggest that an assessment of sexual function should be part of the routine holistic care provided for dermatology outpatients, and highlight the need to screen for cardiovascular risk factors in those with documented ED.
authors.affiliation: Department of Dermatology, University Hospital, Clifford Bridge Road, Walsgrave, Coventry CV2 2DX, UK. jmrgoulding@hotmail.com
authors.forename: J M R
authors.initials: JM
authors.lastname: Goulding
authors.forename: C L
authors.initials: CL
authors.lastname: Price
authors.forename: C L
authors.initials: CL
authors.lastname: Defty
authors.forename: C S
authors.initials: CS
authors.lastname: Hulangamuwa
authors.forename: E
authors.initials: E
authors.lastname: Bader
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000150:complications; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies; D011565:Psoriasis / Q000150:complications*; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires