Abstract
Background:
Psoriasis is a chronic inflammatory papulo-squamous disease characterized by multiple remissions and relapses. This study aimed to assess the impact of psoriasis on the quality of life of patients.
Materials and Methods:
A hospital-based, cross-sectional study was conducted enrolling 198 adult patients of psoriasis. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies were followed. Clinical severity of psoriasis was measured using Psoriasis Area Severity Index (PASI), and quality of life was measured by EuroQoL 5D (EQ-5D-5L, EQ-VAS) and Psoriasis Quality-Of-Life-12 (PQOL-12) Questionniares.
Results:
Of the 198 patients, 71.7% (n = 142/198) were males with a mean age of 41.65 ± 13.19 years. The mean PASI score was 12.46 ± 11.51, and the mean PQOL-12 score was 50.18 ± 23.36. Up to 22.7% (n = 45) cases had ‘severe’ and 6.1% (n = 12) cases has ‘very severe’ PQOL-12 scores. Statistically significant correlation (P < 0.05) was observed between PASI scores and almost all domains of EQ-5D-5L and PQOL-12.
Conclusion:
Psoriasis affects most psycho-social domains of a patient’s life. Coping with these QOL issues remains a challenge to the patients in everyday life. The goal of management of psoriasis therefore must include measures to improve quality of life along with long-lasting remittance of physical symptoms.
KEY WORDS: Pasi, psoriasis, QOL, quality of life
Introduction
Psoriasis is a chronic inflammatory papulosquamous disease characterized by multiple remissions and relapses.[1] It affects approximately 2% of the world’s population.[2] Although psoriasis generally does not cause increased mortality, patients suffer significant decrements in overall emotional well-being, social functioning, and daily physical activities, which can seriously affect patients’ quality of life (QOL).[3] The deleterious effect of psoriasis on QOL has been found to be similar to ischemic heart disease, diabetes, depression, and cancer.[4]
Objective
This study was undertaken to assess the QOL of psoriasis patients.
Materials and Methods
Study design
This was a hospital-based, cross-sectional, observational study, conducted in the Department of Dermatology of a tertiary care hospital in North India from February 2018 to March 2019, after approval from Institutional Ethics Committee (ID. No. AIIMS/IEC/18/98).
Participants
Adult patients of psoriasis, of both genders, were included. Exclusion criteria included patients with psoriatic arthropathy, palmoplantar pustulosis, and nail psoriasis presenting alone without lesions of psoriasis elsewhere.
Data collection
Baseline demographic data (age, gender), relevant medical history, and detailed clinical examination were recorded. The clinical severity of psoriasis was assessed by Psoriasis Area and Severity Index (PASI).[5] Self-assessed QOL questionnaires, EuroQol-5Dimension (EQ-5D-5L),[6] and Psoriasis Quality-Of-Life Questionniare-12 (PQOL-12)[7] in Hindi or English were used to measure QOL.
EuroQol-5Dimension (EQ-5D-5L)[6]
The EuroQol-5Dimension is a standardized generic instrument to assess QOL. It consists of the EQ-5D-5L descriptive system and the EQ visual analogue scale (EQ-VAS). The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has five levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. The patient reports his/her health state by ticking the appropriate statement in each of the five dimensions. The EQ-VAS records the patient’s self-rated health on a visual analogue scale, where the endpoints are labelled as ‘the best health you can imagine’ and ‘the worst health you can imagine’.[6]
Psoriasis Quality-Of-Life Questionniare-12 score or the Koo-Menter Psoriasis Instrument (KMPI)[7].
It is a diagnostic algorithm to identify psoriasis patients with impacts on QOL. It is based on an assessment of the feelings and effects of the previous month. The 12 components include self-consciousness, helplessness, embarrassment, anger/frustration, unsightly appearance, and disfigurement because of the disease, overall emotional well-being, interference with enjoyment, symptoms like itching, physical irritation, physical pain/soreness, and use of clothing to conceal the disease. Each item in PQOL-12 is rated from 0 to 10 for a maximum score of 120. A total score above 50 represents significant a negative impact on QOL due to psoriasis.
Statistical methods
Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 23 (SPSS Inc., Chicago IL, USA). Qualitative variables were summarized by percentages and continuous quantitative variables by mean and standard deviation (SD). Kruskal–Wallis test was applied to study the association of QOL measures (EuroQoL 5D and PQOL-12) with different morphological variants of psoriasis. Spearman’s rank correlation coefficient was used to evaluate the relation between PASI scores and domains of EuroQoL-5D, whereas Kendall’s tau c was used to find the correlation between PQOL-12 scores and PASI. A level of P < 0.05 was considered statistically significant.
Results
The study group consisted of 198 adult patients of psoriasis with a male preponderance (71.7%, n = 142/198) and a male-to-female ratio of 2.54:1. The mean age was 41.65 ± 13.19 years. Maximum patients (28.8%, n = 57/198) were aged 31–40 years. Disease duration ranged from 30 days to 30 years. The most common morphological type was chronic plaque psoriasis (72.7%, n = 144/198). The mean PASI score was 12.46 ± 11.51. Around 35.9% (n = 71/198) of patients had PASI score >12. Clinic-demographic details of patients are in Table 1.
Table 1.
Clinico-demographic details of the study population
| Characteristics | Sub-group | n (%) | ||||
|---|---|---|---|---|---|---|
| Gender | Males | 142 (71.7%) | ||||
| Females | 56 (28.3%) | |||||
| Age (yrs) | 18-30 | 44 (22.2%) | ||||
| 31-40 | 57 (28.8%) | |||||
| 41-50 | 46 (23.2%) | |||||
| 51-60 | 38 (19.2%) | |||||
| >60 | 13 (6.6%) | |||||
| Types of Psoriasis | Chronic plaque | 144 (72.7%) | ||||
| Palmoplantar | 26 (13.1%) | |||||
| Guttate | 6 (3%) | |||||
| Pustular | 3 (1.5%) | |||||
| Erythrodermic | 19 (9.6%) | |||||
| Initial site of involvement | Scalp | 88 (44.4%) | ||||
| Face and neck | 2 (1%) | |||||
| Upper limb | 52 (26.3%) | |||||
| Trunk | 17 (8.6%) | |||||
| Lower limb | 39 (19.7%) | |||||
| PASI scores | Chronic plaque | Palmoplantar | Guttate | Pustular | Erythrodermic | |
| Mild (0-<7) | 62 | 24 | 4 | 0 | 0 | 90 (45.5%) |
| Moderate (7-12) | 35 | 0 | 2 | 0 | 0 | 37 (18.7%) |
| Severe (>12) | 47 | 2 | 0 | 3 | 19 | 71 (35.9%) |
| PQOL-12 scores | Mild (0-30) | 45 (22.7%) | ||||
| Moderate (31-60) | 96 (48.5%) | |||||
| Severe (61-90) | 45 (22.7%) | |||||
| Very severe (91-120) | 12 (6.1%) | |||||
QOL measurement with
EuroQoL 5D questionnaire
Maximal problems in mobility (21.1% reported as ‘severe’, 5.3% as ‘very severe’), self-care (21.1%: ‘severe’, 10.5%: ‘very severe’), effect of disease on usual activities (42.1%: ‘severe’, 5.3%:‘very severe’), pain/discomfort (11.6%: ‘moderate’, 2.5%: ‘severe’), and anxiety/depression (21.1%:‘moderate’) were reported by patients of erythrodermic psoriasis. This was followed by patients with palmo-planter psoriasis who reported problems in mobility and self-care (19.2% each as ‘severe’), and the effect of disease on usual activities (19.2%:‘severe’, 3.8%:‘very severe’). The mean EQ-VAS scores were 69.5 ± 21.9. VAS scores in the range of 76–100 interpreted as ‘worst health that patient can imagine’ were maximally reported by patients of guttate psoriasis (66.6%). The morphological type of psoriasis showed statistically signification association (P < .05) with all domains of EQ-5D-5L questionnaire (Kruskal–Wallis test) [Table 2] and PASI scores (Spearman’s rank correlation) [Table 3]. However, morphological variants of psoriasis showed no statistical association with EQ-VAS.
Table 2.
Association between morphological variants of psoriasis and various domains of EQ-5D-5L and EQ-VAS questionnaire
| Domains of EQ-5D-5L | Types of psoriasis | Chronic plaque | Palmo- plantar | Guttate | Pustular | Erythro- dermic | Total n (%) | Kruskal wallis test, Df=4 |
|---|---|---|---|---|---|---|---|---|
| Problems In Mobility | No | 83 (57.6%) | 5 (19.2%) | 5 (83.3%) | 0 (0) | 1 (5.3%) | 94 (47.5%) | H=42.82 <0.05* |
| Slight | 39 (27.1%) | 11 (42.3%) | 1 (16.7%) | 1 (33.3%) | 6 (31.6%) | 58 (29.3%) | ||
| Moderate | 18 (12.5%) | 5 (19.2%) | 0 (0) | 2 (66.7%) | 7 (36.8%) | 32 (16.2%) | ||
| Severe | 4 (2.8%) | 5 (19.2%) | 0 (0) | 0 (0) | 4 (21.1%) | 13 (6.6%) | ||
| Very severe | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (5.3%) | 1 (0.5%) | ||
| Problems In Self-care | No | 82 (56.9%) | 9 (34.6%) | 5 (83.3%) | 0 (0) | 1 (5.3%) | 97 (49%) | H=43.27 <0.05* |
| Slight | 46 (31.9%) | 7 (26.9%) | 0 (0) | 2 (66.7%) | 2 (10.5%) | 57 (28.8%) | ||
| Moderate | 10 (6.9%) | 5 (19.2%) | 1 (16.7%) | 1 (33.3%) | 10 (52.6%) | 27 (13.6%) | ||
| Severe | 5 (3.5%) | 5 (19.2%) | 0 (0) | 0 (0) | 4 (21.1%) | 14 (7.1%) | ||
| Very severe | 1 (0.7%) | 0 (0) | 0 (0) | 0 (0) | 2 (10.5%) | 3 (1.5%) | ||
| Effect on usual activities | No | 91 (63.2%) | 9 (34.6%) | 4 (66.7%) | 1 (33.3%) | 1 (5.3%) | 106 (53.5%) | H=43.73 <0.05* |
| Slight | 36 (25%) | 8 (30.8%) | 2 (33.3%) | 1 (33.3%) | 4 (21.1%) | 51 (25.8%) | ||
| Moderate | 13 (9%) | 3 (11.5%) | 0 (0) | 1 (33.3%) | 5 (26.3%) | 22 (11.1%) | ||
| Severe | 4 (2.8%) | 5 (19.2%) | 0 (0) | 0 (0) | 8 (42.1%) | 17 (8.6%) | ||
| Very severe | 0 (0) | 1 (3.8%) | 0 (0) | 0 (0) | 1 (5.3%) | 2 (1%) | ||
| Pain/discomfort | No | 100 (69.4%) | 10 (38.4%) | 4 (66.7%) | 3 (100%) | 3 (15.8%) | 120 (60.6%) | H=30.50, <0.05* |
| Slight | 30 (20.8%) | 10 (38.4%) | 2 (33.3%) | 0 (0) | 8 (42.1%) | 50 (25.3%) | ||
| Moderate | 11 (7.6%) | 6 (23.2%) | 0 (0) | 0 (0) | 6 (31.6%) | 23 (11.6%) | ||
| Severe | 3 (2.1%) | 0 (0) | 0 (0) | 0 (0) | 2 (10.5%) | 5 (2.5%) | ||
| Very severe | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Anxiety/depression | No | 91 (63.2%) | 13 (50%) | 4 (66.7%) | 3 (100%) | 3 (15.8%) | 114 (57.6%) | H=16.89, <0.05* |
| Slight | 39 (27.1%) | 12 (46.2%) | 2 (33.3%) | 0 (0) | 12 (63.2%) | 65 (32.8%) | ||
| Moderate | 8 (5.6%) | 1 (3.8%) | 0 (0) | 0 (0) | 4 (21.1%) | 13 (6.6%) | ||
| Severe | 5 (3.5%) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 5 (2.5%) | ||
| Very severe | 1 (0.7%) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.5%) | ||
| VAS Scores | Very low (0-25) | 5 (3.5%) | 0 (0) | 0 (0) | 0 (0) | 2 (10.5%) | H=5.814, >0.05 | |
| Low (26-50) | 30 (20.8%) | 7 (26.9%) | 1 (16.7%) | 1 (33.3%) | 10 (52.6%) | |||
| High (51-75) | 35 (24.3%) | 7 (26.9%) | 1 (16.7%) | 2 (66.7%) | 0 (0) | |||
| Very high (76-100) | 74 (51.4%) | 12 (46.2%) | 4 (66.6%) | 0 (0) | 7 (36.8%) |
Table 3.
Association between various domains of EQ-5D-5L and EQ-VAS questionnaire and PASI scores
| Domains EQ-5D-5L | PASI | Mild | Moderate | Severe | r (Spearman’s rank correlation coefficient) |
|---|---|---|---|---|---|
| Problems In Mobility | No | 55 (61.1%) | 20 (54.1%) | 19 (26.7%) | 0.382 |
| Slight | 24 (26.6%) | 9 (24.3%) | 25 (35.2%) | ||
| Moderate | 6 (6.6%) | 7 (18.9%) | 19 (26.7%) | ||
| Severe | 5 (5.5%) | 1 (2.7%) | 7 (9.8%) | ||
| Very severe | 0 (0) | 0 (0) | 1 (1.4%) | ||
| Problems In Self-care | No | 58 (64.4%) | 22 (59.4%) | 17 (19.7%) | 0.462 |
| Slight | 19 (21.1%) | 12 (32.4%) | 26 (36.6%) | ||
| Moderate | 8 (8.8%) | 3 (8.1%) | 16 (22.5%) | ||
| Severe | 5 (5.5%) | 0 (0) | 9 (12.7%) | ||
| Very severe | 0 (0) | 0 (0) | 3 (4.2%) | ||
| Effect on usual activities | No | 57 (63.3%) | 23 (62.1%) | 26 (36.6%) | 0.472 |
| Slight | 22 (24.4%) | 12 (32.4%) | 17 (23.9%) | ||
| Moderate | 5 (5.5%) | 2 (5.4%) | 15 (21.1%) | ||
| Severe | 5 (5.5%) | 0 (0) | 12 (16.9%) | ||
| Very severe | 1 (1.1%) | 0 (0) | 1 (1.4%) | ||
| Pain/discomfort | No | 64 (71.8%) | 24 (64.8%) | 32 (45.1%) | 0.361 |
| Slight | 20 (22.2%) | 10 (27%) | 20 (28.1%) | ||
| Moderate | 6 (6.6%) | 3 (8.1%) | 14 (19.7%) | ||
| Severe | 0 (0) | 0 (0) | 5 (7%) | ||
| Very severe | 0 (0) | 0 (0) | 0 (0) | ||
| Anxiety/depression | No | 59 (65.5%) | 22 (59.4%) | 33 (46.5%) | 0.314 |
| Slight | 28 (31.1%) | 12 (32.4%) | 25 (35.2%) | ||
| Moderate | 3 (3.3%) | 0 (0) | 10 (14.1%) | ||
| Severe | 0 (0) | 2 (5.4%) | 3 (4.2%) | ||
| Very severe | 0 (0) | 1 (2.7%) | 0 (0) | ||
| VAS Scores | Very low (0-25) | 0 (0) | 0 (0%) | 7 (9.8%) | -2.76 |
| Low (26-50) | 15 (16.6%) | 8 (21.6%) | 26 (36.6%) | ||
| High (51-75) | 21 (23.3%) | 9 (24.3%) | 15 (21.1%) | ||
| Very high (76-100) | 54 (60%) | 20 (54.1%) | 23 (32.4%) |
PQOL-12 questionnaire
The mean PQOL-12 score was 50.18 ± 23.36. Up to 48.5% patients had PQOL-12 scores in the range of 31–60, interpreted as ‘moderate impact on quality of life.’ ‘Very much effect’ was reported by 46% in the domain of ‘overall emotional wellbeing’, 35.4% in ‘helplessness’ and ‘unsightly appearance due to skin lesions’ each, 31.3% in ‘self-consciousness’, 22.7% in ‘anger/frustration’ 21.7% in ‘disfigurement’, 16.7% in ‘interference of self-enjoyment’, 14.1% in ‘embarrassment’, and 13.6% in ‘use of clothes to conceal lesions’. ‘Much effect on QOL’ was reported by 50.5% in ‘physical irritation’, 50% in ‘itch’, and 43.9% in ‘pain/soreness’. Response in various domains of PQOL-12 questionnaire are in Table 4. Statistically significant association was noted between the the PQOL-12 scores and PASI scores (Kendall’s Tau c test, P < 0.05) but not with morphological types of psoriasis [Table 5]. Also, all components of the PQOL-12 questionnaire (excluding domain of self- consciousness) showed statistically significant association with PASI scores (P < 0.05) [Table 6].
Table 4.
Response in various domains of PQOL-12 questionnaire
| Domains PQOL-12 Questionnaire | Response n (%) | ||
|---|---|---|---|
|
| |||
| Less problem | Much problem | Very much problem | |
| Self-consciousness | 7 (3.5%) | 129 (65.2%) | 62 (31.3%) |
| Helplessness | 30 (15.2%) | 98 (49.5%) | 70 (35.4%) |
| Embarrassment | 14 (7.1%) | 156 (78.8%) | 28 (14.1%) |
| Angry/frustration | 33 (16.7%) | 120 (60.6%) | 45 (22.7%) |
| Unsightly appearance | 56 (28.3%) | 72 (36.4%) | 70 (35.4%) |
| Disfiguring | 79 (39.9%) | 76 (38.4%) | 43 (21.7%) |
| Overall emotional wellbeing | 91 (46%) | 16 (8.1%) | 91 (46%) |
| Interference with enjoyment | 95 (48%) | 70 (35.4%) | 33 (16.7%) |
| Itching | 95 (48%) | 99 (50%) | 4 (2%) |
| Physical irritation | 97 (49%) | 100 (50.5%) | 1 (0.5%) |
| Physical pain/soreness | 104 (52.5%) | 87 (43.9%) | 7 (3.5%) |
| Clothing to conceal | 87 (43.9%) | 84 (42.4%) | 27 (13.6%) |
Table 5.
Association of PQOL-12 scores with different morphological variants of psoriasis and PASI scores
| Types of psoriasis | PQOL-12 scores | P | |||
|---|---|---|---|---|---|
|
| |||||
| Mild (0-30) | Moderate (31-60) | Severe (61-90) | Very severe (91-120) | ||
| Chronic plaque | 35 (24.3%) | 68 (47.2%) | 35 (24.3%) | 6 (4.2%) | Kruskal Wallis test, P>0.05 |
| Palmoplantar | 4 (15.4%) | 19 (73.1%) | 2 (7.7%) | 1 (3.8%) | |
| Guttate | 1 (16.7%) | 4 (66.7%) | 1 (16.7%) | 0 (0) | |
| Pustular | 0 (0) | 2 (66.7%) | 1 (33.5%) | 0 (0) | |
| Erythrodermic | 5 (26.3%) | 3 (15.8%) | 9 (31.6%) | 5 (26.3%) | |
| PASI scores | |||||
| Mild (0-<7) | 26 (28.9%) | 48 (53.3%) | 15 (16.7) | 1 (1.1%) | <0.05 (Kendall7) tau c) |
| Moderate (7-12) | 10 (27%) | 20 (54.1%) | 6 (16.2%) | 1 (2.7%) | |
| Severe(>12) | 9 (27.7%) | 28 (39.4%) | 24 (33.8%) | 10 (14.1%) | |
Table 6.
Association between 12 components of PQOL-12 questionnaire and PASI scores
| Components of PQOL-12 score | Kendallnt Tau c (P) |
|---|---|
| Self-consciousness | 0.052 |
| Helplessness | 0.004* |
| Embarrassment | 0.005* |
| Angry/frustration | 0.002* |
| Unsightly appearance | 0.006* |
| Disfiguring | <0.005 |
| Overall emotional wellbeing | <0.005 |
| Interference with enjoyment | <0.005 |
| Itching | <0.005 |
| Physical irritation | <0.005 |
| Physical pain/soreness | <0.005 |
| Clothing to conceal | <0.005 |
Discussion
Revicki and colleagues define QOL as “a broad range of human experiences related to one’s overall well-being’’.[8] A moderate impact on QOL was reported by almost half of the patients (48.5%, n = 96/198) in this study. Krueger G. et al. reported that up to 75% of psoriasis patients had moderate to severe negative impacts on QOL.[9] The maximal PQOL-12 score of 110 found in this study is similar to that reported by Shankar et al.[10]
Most patients reported problems in all domains of EuroQoL, that is, mobility, self-care, effect on daily activities, and pain. In a systematic review by de Korte J et al., physical functioning/mobility-related activities like walking, carrying, climbing stairs, self-care activities (e.g., bathing), and essential daily work were found to be impaired in psoriasis.[11] In the PQOL-12 questionnaire, ‘very much problem’ was reported by 35.4% in the domain of ‘unsightly appearance’ and 31.3% in the domain of self-consciousness, 21.7% in the domain of ‘disfigurement’, 14.1% in embarrassment, and 22.7% in the domain of ‘anger/frustration’. Psoriasis is associated with significant psychological distress, including dysfunctional thought, pathological worrying, fear of stigmatization, effects on self-image, personality, and temperament.[12] Problems with sports and sexual activities and visits to the hairdresser are reported. Relationships with family, relatives, friends, and the establishment of social contacts and new friendships appeared to be impaired.[11] ‘Very much problem’ was reported by 13.6% of patients in this study, in the domain of having to use ‘clothes to conceal’ skin lesions. Patients with visible psoriatic lesions have significantly worse QOL compared to those with non-visible lesions.[13] In the Indian context, the social stigma attached to skin diseases further adds to the difficulty in getting employment and marriage alliances. Itching as a symptom in psoriatics remains has been reported in only a few studies. In this study, about 50% reported ‘much effect on QOL’ due to ‘itch’ and ‘physical irritation’. In a study by Ljosaa T et al., unpleasant, surface, sensitive, itchy, and hot/burning were the most common symptoms reported and sleep was the most severely affected function.[14]
In the EuroQol questionnaire, ‘moderate’ anxiety/depression was reported by 21.1% of patients with erythrodermic psoriasis, whereas ‘severe’ to ‘very severe’ anxiety/depression was reported by 3.5% and 0.7% patients of chronic plaque psoriasis, respectively. Also, in the PQOL-12 questionnaire, ‘very much effect’ in the domain of ‘overall emotional wellbeing’ was reported by 46% of patients and 34.4% in ‘helplessness’. Impaired mental health (anxiety/depression, loss of behavioral or emotional control, psychological well-being) and emotional reactions (shame, embarrassment, self-consciousness, anger, helplessness) amongst psoriatics have been highlighted by de Korte J et al.[11] In another systematic review, anxiety and depression were prevalent in 30.4% and 27.6% of patients, respectively.[15] Evidence in the literature suggests depression may cause inflammation or vice versa. Numerous pro-inflammatory cytokines like IL-6, TNFa, IL-2, IL-b, C-reactive protein (CRP), and PGE-2 are elevated in major depressive disorder as well as in states of psychological stress. This results in an acute rise in levels of pro-inflammatory cytokines in the circulation that exacerbate psoriasis.[16]
Overall, patients of erythrodermic and palmo-planter psoriasis reported more severe impacts on QOL compared to other morphological variants. ‘Severe’ to ‘very severe’ effects were noted on domains like mobility, self-care, effect of disease on daily activities, pain/discomfort, and anxiety/depression. This may be attributed to physical symptoms of fatigue, malaise, skin tightness and systemic complications of erythroderma. Palmo-planter psoriasis affects locations that are crucial for daily function. Compared with moderate to severe plaque psoriasis, palmoplantar psoriasis is independently associated with a greater impact on skin-related QOL, a greater impairment of mobility, self-care, and usual activities and a greater dependency on topical medications.[17] Interestingly, high VAS scores (71–100) were reported maximally in guttate psoriasis (66.6%). Also, no association was noted between PASI scores and EQ-VAS. We infer that that even minimal body surface area involvement may be perceived by individual patients as ‘worst health’.
Positive correlation between PASI and psoriasis disability index (PDI)[18] and Dermatology Life Quality Index (DLQI)[19] has been reported by Indian authors. In this study, statistically significant association was noted between PASI and all five domains of EQ-5D-5L questionnaire and PQOL-12 scores. Psoriasis of face, hands, or genitals may have a disproportionate effect on QOL, resulting in high QOL scores with a relatively low PASI. Alternatively, a mismatch between a low PASI and significantly impaired QOL score can also suggest comorbid depression, and psychological evaluation and support should be considered under these circumstances.[12] Hence, isolated PASI scores alone should not be used to decide treatment options in psoriasis.
This is the first Indian study to use one general measure (EQ-5D-5L) and one disease-specific measure (PQOL-12) to assess the effect of psoriasis on the various psycho-social domains of a patient’s life. The major limitations of this study include the study setting of a tertiary care hospital, which meant that the patients with severe/treatment-resistant psoriasis may have been included in the study.
Conclusion
In conclusion, the findings of this study highlight the profound effect of psoriasis on QOL so much so that day-to-day living may pose as a challenge. It is pertinent to adopt a broader multi-dimensional assessment of psoriasis that also includes QOL indices in monitoring treatment response.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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