Ann Dermatol.  2010 Nov;22(4):389-396. 10.5021/ad.2010.22.4.389.

Impact of Psoriasis on Quality of Life: Relationship between Clinical Response to Therapy and Change in Health-related Quality of Life

• Lee YW
• Park EJ
• Kwon IH
• Kim KH
• Kim KJ

• KMID: 2266174
• DOI: http://doi.org/10.5021/ad.2010.22.4.389

Abstract

BACKGROUND
Psoriasis exerts significant, negative, impact on patients' quality of life (QOL). Recently, the relationship between QOL and skin lesion improvement has been emphasized in the treatment of psoriasis patients.
OBJECTIVE
The purpose of study was to compare the QOL in psoriasis and other skin diseases, and to evaluate the generic QOL, skin specific QOL, stress, depression and anxiety before and after treatment in patients.
METHODS
A total of 138 patients with psoriasis were recruited in this study and 83 patients complete the questionnaire at week 16. Questionnaires were comprised of generic WHO QOL scale, dermatology specific questionnaires (Skindex-29), psoriasis life stress inventory (PLSI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Clinical response was assessed by the PASI.
RESULTS
After treatment, health-related QOL was improved and PASI improvement showed smaller correlation with Skindex-29, compared with the correlations between self-reported severity score (SRSS) improvement and Skindex-29. Regression analysis revealed that duration, SRSS, stress, and depression were factors affecting baseline HRQOL in patients, and age, duration, and SRSS were predictors associated with HTQOL score changes.
CONCLUSION
Treatment improved HRQOL, BAI, BDI, and PLSI scores. Psoriasis may become more burdensome in groups of patients who suffer long disease duration, high SRSS, depression, and stressful environments.

Keyword

Psoriasis; Quality of life

MeSH Terms

Anxiety
Depression
Dermatology
Humans
Psoriasis
Quality of Life
Skin
Skin Diseases
Stress, Psychological
Surveys and Questionnaires

Figure

• 

  Fig. 1 Mean change for the WHOQOL-BREF, Skindex-29, BAI, BDI, PLSI, PASI, and SRSS between baseline and week 16 (*p<0.01, †p<0.001, Wilcoxon rank sum test). WHOQOL-BREF: WHO quality of life scale, BAI: Beck anxiety inventory, BDI: Beck depression inventory, PLSI: psoriasis life stress inventory, PASI: psoriasis area and severity index; SRSS: self-reported severity score.

Reference

1. Naldi L. Health-related quality of life: from health economics to bedside? Dermatology. 2007. 215:273–276.

2. Both H, Essink-Bot ML, Busschbach J, Nijsten T. Critical review of generic and dermatology-specific health-related quality of life instruments. J Invest Dermatol. 2007. 127:2726–2739.

3. Shumaker SA, Naughton MJ. Shumaker SA, Berzon RA, editors. The international assessment of health-related quality of life. The international assessment of health-related quality of life: theory, translation, measurement, and analysis. 1995. New York: Rapid Communications;3–10.

4. Hahl J, Hämäläinen H, Sintonen H, Simell T, Arinen S, Simell O. Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications. Qual Life Res. 2002. 11:427–436.

5. Wang R, Zhao Y, He X, Ma X, Yan X, Sun Y, et al. Impact of hypertension on health-related quality of life in a population-based study in Shanghai, China. Public Health. 2009. 123:534–539.

6. Fleischmann KE, Orav EJ, Lamas GA, Mangione CM, Schron EB, Lee KL, et al. Atrial fibrillation and quality of life after pacemaker implantation for sick sinus syndrome: data from the Mode Selection Trial (MOST). Am Heart J. 2009. 158:78–83.

7. Djärv T, Blazeby JM, Lagergren P. Predictors of postoperative quality of life after esophagectomy for cancer. J Clin Oncol. 2009. 27:1963–1968.

8. Moser DK, Yamokoski L, Sun JL, Conway GA, Hartman KA, Graziano JA, et al. Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure. J Card Fail. 2009. 15:763–769.

9. Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999. 41:401–407.

10. Finlay AY, Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol. 1995. 132:236–244.

11. WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998. 28:551–558.

12. Min SK, Kim KI, Lee CI, Jung YC, Suh SY, Kim DK. Development of the Korean versions of WHO quality of life scale and WHOQOL-BREF. Qual Life Res. 2002. 11:593–600.

13. Chen T, Bertenthal D, Sahay A, Sen S, Chren MM. Predictors of skin-related quality of life after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma. Arch Dermatol. 2007. 143:1386–1392.

14. Ahn BK, Lee SJ, Namkoong K, Chung YL, Lee SH. The Korean version of Skindex-29. Korean J Dermatol. 2004. 42:9–15.

15. Gupta MA, Gupta AK. The Psoriasis Life Stress Inventory: a preliminary index of psoriasis-related stress. Acta Derm Venereol. 1995. 75:240–243.

16. Yook SP, Kim ZS. A clinical study on the Korean version of Beck anxiety inventory: comparative study of patient and non-patient. Korean J Clin Psychol. 1997. 16:185–197.

17. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961. 4:561–571.

18. Hahn HM, Yum TH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A standardization study of Beck Depression Inventory in Korea. J Korean Neuropsychiatr Assoc. 1986. 25:487–500.

19. Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R. Quality of life in patients with psoriasis. Health Qual Life Outcomes. 2006. 4:35.

20. Fortune DG, Richards HL, Griffiths CE. Psychologic factors in psoriasis: consequences, mechanisms, and interventions. Dermatol Clin. 2005. 23:681–694.

21. Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T. The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol. 2001. 137:280–284.

22. Pearce DJ, Singh S, Balkrishnan R, Kulkarni A, Fleischer AB, Feldman SR. The negative impact of psoriasis on the workplace. J Dermatolog Treat. 2006. 17:24–28.

23. Fava GA, Perini GI, Santonastaso P, Fornasa CV. Life events and psychological distress in dermatologic disorders: psoriasis, chronic urticaria and fungal infections. Br J Med Psychol. 1980. 53:277–282.

24. Al'Abadie MS, Kent GG, Gawkrodger DJ. The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. Br J Dermatol. 1994. 130:199–203.

25. Fortune DG, Richards HL, Kirby B, McElhone K, Main CJ, Griffiths CE. Successful treatment of psoriasis improves psoriasis-specific but not more general aspects of patients' well-being. Br J Dermatol. 2004. 151:1219–1226.

26. Unaeze J, Nijsten T, Murphy A, Ravichandran C, Stern RS. Impact of psoriasis on health-related quality of life decreases over time: an 11-year prospective study. J Invest Dermatol. 2006. 126:1480–1489.

27. Fried RG, Friedman S, Paradis C, Hatch M, Lynfield Y, Duncanson C, et al. Trivial or terrible? The psychosocial impact of psoriasis. Int J Dermatol. 1995. 34:101–105.

28. Devrimci-Ozguven H, Kundakci TN, Kumbasar H, Boyvat A. The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. J Eur Acad Dermatol Venereol. 2000. 14:267–271.

29. Zachariae R, Zachariae C, Ibsen H, Mortensen JT, Wulf HC. Dermatology life quality index: data from Danish inpatients and outpatients. Acta Derm Venereol. 2000. 80:272–276.

30. Koo J. Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin. 1996. 14:485–496.

31. Fortune DG, Richards HL, Main CJ, Griffiths CE. Patients' strategies for coping with psoriasis. Clin Exp Dermatol. 2002. 27:177–184.