Health-related quality of life in patients with psoriasis: a systematic review of the European literature

Defining well-being in psoriasis: A Delphi consensus among healthcare professionals and patients

Psoriasis is a chronic skin disease that negatively impacts on patient's life. A holistic approach integrating well-being assessment could improve disease management. Since a consensus definition of well-being in psoriasis is not available, we aim to achieve a multidisciplinary consensus on well-being definition and its components. A literature review and consultation with psoriasis patients facilitated the design of a two-round Delphi questionnaire targeting healthcare professionals and psoriasis patients. A total of 261 panellists (65.1% patients with psoriasis, 34.9% healthcare professionals) agreed on the dimensions and components that should integrate the concept of well-being: emotional dimension (78.9%) [stress (83.9%), mood disturbance (85.1%), body image (83.9%), stigma/shame (75.1%), self-esteem (77.4%) and coping/resilience (81.2%)], physical dimension (82.0%) [sleep quality (81.6%), pain/discomfort (80.8%), itching (83.5%), extracutaneous manifestations (82.8%), lesions in visible areas (84.3%), lesions in functional areas (85.8%), and sex life (78.2%)], social dimension (79.5%) [social relationships (80.8%), leisure/recreational activities (80.3%), support from family/friends (76.6%) and work/academic life (76.5%)], and satisfaction with disease management (78.5%) [treatment (78.2%), information received (75.6%) and medical care provided by the dermatologist (80.1%)]. This well-being definition reflects patients' needs and concerns. Therefore, addressing them in psoriasis will optimise management, contributing to better outcomes and restoring normalcy to the patient's life.

New-Onset Hidradenitis Suppurativa in Psoriasis Patients: A Multi-Center, Retrospective Cohort Study

BACKGROUND

Previous research has indicated a potential correlation between hidradenitis suppurativa (HS) and psoriasis (PSO), two chronic inflammatory dermatological diseases. However, there is a lack of comprehensive evaluations that consider a variety of clinical and demographic factors, and the risk of developing HS in PSO patients remains unclear. Our study aims to examine HS risk over time among PSO patients versus matched controls while considering the influence of confounders to provide insights into the potential link between these two diseases.

METHOD

In this multi-institutional cohort study using the TriNetX database, we matched 202,318 patients with PSO with an equivalent number of individuals without PSO, using propensity score matching. The study period extended from 1 January 2005 to 31 December 2018. We computed hazard ratios and their respective 95% confidence intervals (CIs) to evaluate the probability of HS manifestation over a period of 5 years in patients with PSO in comparison to those without PSO.

RESULTS

PSO patients demonstrated a consistently higher risk of developing HS than matched controls across all analytic models with the hazard ratios (HR) ranging from 1.43 (95% CI 1.30-1.56) to 5.91 (95% CI 2.49-14.04). Stratified analyses showed the increased HS risk was observed in both genders but only significant in those aged 18-64 years. Kaplan-Meier analysis indicated PSO patients had a higher cumulative probability of developing HS over time (HR 1.77, 95% CI 1.49-1.89).

CONCLUSIONS

PSO was associated with increased HS risk, highlighting the importance of considering HS as a potential comorbidity in PSO patients and may have implications for early detection, prevention, and management strategies for both conditions. Shared inflammatory pathways, genetic components, and skin dysbiosis may contribute. Further research should elucidate underlying mechanisms.

3D-QSAR pharmacophore modeling, virtual screening, molecular docking, MD simulations, in vitro and in vivo studies to identify potential anti-hyperplasia drugs

Psoriasis is a common immune-mediated skin condition characterized by aberrant keratinocytes and cell proliferation. The purpose of this study was to explore the FDA-approved drugs by 3D-QSAR pharmacophore model and evaluate their efficiency by in-silico, in vitro, and in vivo psoriasis animal model. A 3D-QSAR pharmacophore model was developed by utilizing HypoGen algorithm using the structural features of 48 diaryl derivatives with diverse molecular patterns. The model was validated by a test set of 27 compounds, by cost analysis method, and Fischer's randomization test. The correlation coefficient of the best model (Hypo2) was 0.9601 for the training set while it was 0.805 for the test set. The selected model was taken as a 3D query for the virtual screening of over 3000 FDA-approved drugs. Compounds mapped with the pharmacophore model were further screened through molecular docking. The hits that showed the best docking results were screened through in silico skin toxicity approach. Top five hits were selected for the MD simulation studies. Based on MD simulations results, the best two hit molecules, that is, ebastine (Ebs) and mebeverine (Mbv) were selected for in vitro and in vivo antioxidant studies performed in mice. TNF-α and COX pro-inflammatory mediators, biochemical assays, histopathological analyses, and immunohistochemistry observations confirmed the anti-inflammatory response of the selected drugs. Based on these findings, it appeared that Ebs can effectively treat psoriasis-like skin lesions and down-regulate inflammatory responses which was consistent with docking predictions and could potentially be employed for further research on inflammation-related skin illnesses such as psoriasis.

Factors associated with quality of life in Chinese people with psoriasis: a cross-sectional study

BACKGROUND

The ultimate goal of medical care is to eradicate disease and restore normality to a person's life. Quality of life (QOL) is a concern as dermatologists and researchers strive to find better drug treatments. However, there have been few reports on the factors associated with QOL among Chinese people with psoriasis.

METHODS

A total of 185 people with psoriasis were surveyed to assess their sociodemographic status, disease-related information, psychosocial status, and QOL. The questionnaires included a sociodemographic questionnaire, the Athens Insomnia Scale, the Hospital Anxiety and Depression Scale, the Perceived Social Support Scale, the Psychosocial Adaptation Questionnaire of Chronic Skin Disease and the Dermatology Life Quality Index. Multiple stepwise regression and path analysis were used to study the factors associated with QOL among Chinese people with psoriasis and to analyse the relationship between them.

RESULTS

The results showed that the presence of anxiety/depression, lesion area, sleep disorders, psychosocial adaptation, and sex could jointly predict 62.1% of the variance in QOL among Chinese people with psoriasis. According to previous theories and the literature, a path model was established for five variables. Four internal variables could be effectively explained. The values of the explanatory variables were 62.1% (F(1056) = 61.020, p = 0.000) for QOL, 71.8% (F(2433) = 117.370, p = 0.000) for anxiety/depression, 44.0% (F(660) = 36.935, p = 0.000) for sleep disorders, and 66.9% (F(6886) = 93.556, p = 0.000) for psychosocial adaptation. The path analysis confirmed that 9 paths were consistent with the predicted path, and 3 paths were not confirmed.

CONCLUSION

To improve QOL among Chinese people with psoriasis, attention should be given to the presence of anxiety/depression, lesion area, sleep disorders, psychosocial adaptation and sex differences. Therefore, health care programs for psoriasis should include physical, psychological and social aspects.

Treatment Preferences in Young Adults with Moderate to Severe Psoriasis: A Qualitative Study from the Nordic Countries

INTRODUCTION

The purpose of this study is to explore treatment preferences and identify patient characteristics in young bio-naive adults with moderate to severe psoriasis in the Nordic countries (Norway, Finland, Sweden, and Denmark).

METHODS

Patients were 18-45 years old and bio-naive but referred for biologic treatment of moderate to severe psoriasis. Patients were included at eight Nordic dermatology clinics. Patients with significant comorbidity or psoriatic arthritis were excluded. The Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were assessed along with basic patient information. A semistructured interview guide was used in individual qualitative interviews, asking patients about their treatment preferences and reasons, disease journey, and disease management. The interviews were analyzed using thematic content analysis. Twenty-four patients sufficed to reach saturation in this qualitative study.

RESULTS

The patient sample characteristics represented a qualitative variation in age, sex, symptoms, duration of disease, and country. We included a total of 12 male and 12 female patients. The mean age was 34 years (range 18-45 years), the mean age at diagnosis was 20 years (range 6-34 years), the mean ± standard deviation (SD) time since diagnosis was 13 ± 8 years, PASI was 9.5 ± 4.7, and DLQI was 15.2 ± 6.4. Interviews suggested that both the burden of disease as well as the burden of treatment influenced patient preferences regarding treatment attributes, hence getting alleviation from symptoms did not alone influence patient preferences. Time, effort, and inconvenience related to psoriasis treatments also influenced patient preferences.

CONCLUSIONS

This first in-depth, qualitative study in young bio-naive adults with psoriasis suggests that patient preferences are focusing not only on symptom relief but also on alleviating the burden of psoriasis treatment. Understanding the reasons for patient preferences and the perspectives of young adults is needed to guide individual shared decision-making in psoriasis management.

Factors associated with worsened clinical symptoms of psoriasis and disease-related quality of life during the COVID-19 lockdown: A cross-sectional study

Objective

In this cross-sectional study, we aimed to evaluate the factors associated with psoriasis symptom worsening and impaired quality of life (QoL) in individuals with psoriasis during the COVID-19 pandemic lockdown.

Methods

During the second COVID-19 national lockdown (January-April 2021) in Lithuania, individuals diagnosed with psoriasis were invited to fill in an anonymous online survey including sociodemographic and life-style factors, psoriasis-related clinical symptoms, the Dermatology Life Quality Index (DLQI) and the Patients' Health Questionnaire (PHQ).

Results

A total of 297 respondents completed the survey. The majority of them (52.5%) reported worsened clinical symptoms of psoriasis during the COVID-19 lockdown period. In total, 43.1% of responders reported significant depressive symptoms (PHQ-9 ≥ 10) and 23.6% reported impaired disease-related QoL (DLQI > 10). The strongest predictor of psoriasis symptoms worsening was the need for changes in psoriasis treatment, with an odds ratio (OR) of 2.73 (95% CI 1.37-5.44, p = 0.004) and decreased income (OR = 2.33, 95% CI 1.30-4.17, p = 0.004). The strongest predictor of impaired QoL was male sex (OR = 3.35, 95% CI 1.70-6.59, p < 0.001). Contribution of specific depressive symptoms was evident for both models.

Conclusion

Worsening of psoriasis symptoms during the COVID-19 lockdown was associated with decreased income, psoriasis treatment changes and depression symptoms. Impaired QoL was associated with male sex, symptom worsening and depression. Specific depression symptoms may have contributed to more symptom worsening and impaired QoL than the depressive symptomatology as a whole.

Efficacy of Secukinumab in Psoriasis: Post Hoc Gender-Wise Analysis of the SUPREME Study

Purpose

Psoriasis, a common systemic inflammatory disorder, presents with gender-related differences in the quality of life (QoL) and treatment outcomes. This post hoc analysis from the Phase 3b SUPREME study explored gender-related differences in patient characteristics and efficacy of secukinumab 300 mg on Psoriasis Area and Severity Index (PASI) 75/90/100 and impact on QoL using the Dermatology Life Quality Index (DLQI) in patients with moderate to severe psoriasis through week 24.

Patients and Methods

The proportion of patients achieving PASI 75/90/100 was computed using a nonresponder imputation approach. Differences between cohorts were analyzed using a logistic regression model. The mean change from baseline in DLQI was computed using the Wilcoxon test.

Results

Among the 433 patients (males: 71.6%), females had a higher DLQI than males at baseline (13.1 vs 9.5; P<0.0001). Males had a slightly higher response for PASI 90 than females at week 16 (80.7% vs 78.1%; P=0.0779) and 24 (83.2% vs 79.7%; P=0.0319). No differences were observed between genders in PASI 100/75 responses at week 24. Both genders showed an improvement in DLQI with secukinumab at week 24 (-10.9 vs -8.1, respectively, in females vs males; P=0.0004).

Conclusion

In summary, secukinumab was effective in the treatment of psoriasis, irrespective of gender.

Psoriasis hastalarında sigara içme durumu ile yaşam kalitesi arasındaki ilişkide hastalık şiddetinin aracı etkisi

Purpose: The aim of this study was to examine the relationship between smoking and quality of life and to investigate the mediating role of disease severity on this relationship in psoriasis patients. Materials and Methods: In the study, 268 psoriasis patients were reached by the convenience sampling method. In the study, patients' quality of life was measured with “dermatology quality of life index (DLQI)” and disease severity was measured with “psoriasis area and severity index (PASI)”. The effect of the independent variable (smoking) on the dependent variable (quality of life), both directly and indirectly through the mediating variable (disease severity), was examined by process analysis. Results: Smoking status shows statistically significant differences according to gender, age, marital status, occupation, and income groups. 17.02% of women and 44.09% of men smoke. 19.74% of single and 33.85% of married smoke. 20% of unemployed and 39.13% of employees smoke. 17.76% of low-income, 50.91% of middle-income, and 40.98% of high-income people smoke. This cross-sectional study revealed that smoking in psoriasis has no direct effect on the quality of life, but that smoking has a full indirect effect on the quality of life through disease severity. Conclusion: In the study, it was found that smoking negatively affects the quality of life through both disease severity. Accordingly, it is recommended that patients be informed about the effect of smoking on their diseases.

Impact of moderate-to-severe psoriasis on quality of life in China: a qualitative study

Purpose

Psoriasis is a serious health problem. Since limited research has investigated the impact of psoriasis on the quality of life of patients with moderate-to-severe psoriasis, this study aimed to explore this issue.

Methods

A qualitative study was conducted with 22 psoriasis patients from two cities in Shandong province of eastern China participating in one-to-one semi-structured in-depth interviews.

Results

Thematic analysis generated five major themes: (1) Symptoms, symptoms management and pain; (2) Functioning and activities of daily living (ADLs); (3) Psychological impact; (4) Social impact; (5) Employment and finances.

Conclusion

Our study detailed the effects of psoriasis on patients’ symptoms, symptoms management and pain, functioning and activities of daily living (ADLs), psychological impact, social impact, employment and finances. These data can provide a reference for studying the quality of life in patients with psoriasis.

Individual Differences in Emotion Dysregulation and Social Anxiety Discriminate between High vs. Low Quality of Life in Patients with Mild Psoriasis

A deeper understanding of how health-related quality of life relates to the clinical and individual characteristics of patients is essential for the delivery of patient-centered dermatological care. The current study aimed to examine the role of individual differences in emotion dysregulation and social anxiety in modulating quality of life in psoriatic patients. A total of 130 patients affected by psoriasis were consecutively enrolled in the study as they approached the Dermatology Unit of Sant'Orsola-Malpighi Hospital of Bologna. Clinical information gathered included illness severity, assessed with the Psoriasis Area and Severity Index (PASI) and the Body Surface Area (BSA); illness onset; familiarity; and prescribed treatment. The patient-reported outcome measures were the Dermatology Life Quality Index (DLQI), measuring the patient's quality of life; the Psoriasis Skin Appearance Bothersomeness scale (PSAB), measuring patient's perception of illness severity; the Difficulties in Emotion Regulation Scale (DERS), assessing emotion dysregulation traits; and the Social Interaction Anxiety Scale (SIAS), measuring anxiety about social interactions. Patients with moderate-to-severe psoriasis reported significantly lower quality of life compared to mildly affected patients. In addition, of the patients affected by mild psoriasis, those characterized by emotion dysregulation and social anxiety traits showed significantly lower levels of quality of life. Our findings suggest that individual differences in emotion dysregulation and social anxiety contribute to health-related quality of life in addition to illness severity. Therapeutic approaches that combine dermatological care with psychological support, especially focused on emotional regulation skills, may be useful to improve clinical outcomes in patients with psoriasis.

Skin Barrier Dysregulation in Psoriasis

The skin barrier is broadly composed of two elements-a physical barrier mostly localised in the epidermis, and an immune barrier localised in both the dermis and epidermis. These two systems interact cooperatively to maintain skin homeostasis and overall human health. However, if dysregulated, several skin diseases may arise. Psoriasis is one of the most prevalent skin diseases associated with disrupted barrier function. It is characterised by the formation of psoriatic lesions, the aberrant differentiation and proliferation of keratinocytes, and excessive inflammation. In this review, we summarize recent discoveries in disease pathogenesis, including the contribution of keratinocytes, immune cells, genetic and environmental factors, and how they advance current and future treatments.

Correlation Between Change in Psoriasis Area and Severity Index and Dermatology Life Quality Index in Patients with Psoriasis: Pooled Analysis from Four Phase 3 Clinical Trials of Secukinumab

INTRODUCTION

Patients with psoriasis (PsO) experience impaired health-related quality of life due to physical and psychosocial burdens. The objective of this study was to assess the correlation between change in Psoriasis Area and Severity Index (PASI) score and selected Dermatology Life Quality Index (DLQI) domain scores in patients with moderate-to-severe PsO and those with PsO and comorbid psoriatic arthritis (PsA).

METHODS

This post hoc analysis of four phase 3 clinical trials included patients with moderate-to-severe PsO randomized to secukinumab 150/300 mg, etanercept, or placebo. Pairwise latent growth models were applied to assess the longitudinal correlation between change in PASI scores and changes in three DLQI domain scores (daily activities, leisure activities, and symptoms/feelings). The initial (baseline to week 12) and sustained (week > 12 to week 52) treatment exposures were analysed by population type (total, PsO only, and PsO with comorbid PsA) and treatment arm (secukinumab, etanercept, or placebo).

RESULTS

Among the total population (N = 2401), PASI change was positively correlated with change in each assessed DLQI domain; correlations were weak to moderate over the initial treatment exposure period (β range, 0.20-0.29; all P < 0.001) and moderate to strong over the sustained exposure period (β range, 0.63-0.69; all P < 0.001). Similar trends were observed regardless of the presence of comorbid PsA. These relationships were confirmed among patients treated with secukinumab, etanercept, or placebo.

CONCLUSIONS

Improvements in PASI scores were directly moderately related to improvements in DLQI domain scores from initiation of treatment and extended over time, regardless of presence of comorbid PsA or treatment received.

CLINICAL TRIAL REGISTRATION

ERASURE (NCT01365455), FIXTURE (NCT01358578), FEATURE (NCT01555125), and JUNCTURE (NCT01636687).

Impact of skin, musculoskeletal and psychosocial aspects on quality of life in psoriatic arthritis patients: A cross-sectional study of outpatient clinic patients in the biologic treatment era

BACKGROUND

In psoriatic arthritis (PsA), both psoriasis and musculoskeletal manifestations may impair Health-Related Quality of Life (HRQoL). Our objective was to explore the impact of the various disease manifestations and disease consequences, including psychosocial factors, on HRQoL in PsA patients treated in the biologic treatment era.

METHODS

Data collection in the 131 outpatient clinic PsA patients assessed included demographics, disease activity measures for both skin and musculoskeletal involvement and patient-reported outcome (PRO) measures, treatment and psychosocial burden. The skin dimension of quality of life was assessed by the Dermatology Life Quality Index (DLQI) and the overall HRQoL by the 15-Dimensional (15D) Questionnaire.

RESULTS

The mean age was 51.9 years, PsA disease duration 8.6 years, 50.4% were men, 56.9% were employed/working and 47.7% had ≥1 comorbidities. Prevalence of monotherapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was 36.6% and with biologic DMARDs 12.2% and combination of both 22.9%. Mean DLQI was 3.3 and 15D 0.84. In adjusted analysis, not employed/working, higher scores for fatigue, sleep disturbances, anxiety and depression, Modified Health Assessment Questionnaire and presence of comorbidities were independently associated with impaired HRQoL (lower 15D scores), whereas Psoriasis Area Severity Index (PASI) and DLQI were not. Younger age and higher Psoriatic Arthritis Disease Activity Score and PASI scores were independently associated with impaired skin quality of life (higher DLQI score).

CONCLUSION

Our study highlights the negative impact the psychosocial burden, impaired physical function and comorbidities has on reduced HRQoL in PsA outpatients. Thus, to further improve HRQoL in PsA patients, not only physical concerns but also psychological concerns need to be addressed.

PASI 100 response rates in moderate to severe psoriasis: a systematic literature review and analysis of clinical practice guidelines

BACKGROUND

Response to treatments in psoriasis can be assessed using the PASI response 50, 75, 90 or 100. Achieving a PASI 100 response would mean a complete resolution of the patient's basal lesions. Therefore, PASI 100 score has been increasingly used in the context of research, but its role in daily practice is currently controversial.

OBJECTIVE

(1) To analyze PASI 100 response rates to pharmacological treatments; (2) To examine clinical practice guidelines (CPGs) recommendations/comments on PASI 100.

METHODS

We conducted a systematic literature review (SLR). Selection criteria concerned patients with psoriasis, reporting PASI 100.

RESULTS

Overall, 65 studies were included. Patients on methotrexate achieved at 16 weeks a PASI 100 of 7.3%. For TNF inhibitors rates were: 3.7-11.1% at 12 weeks, 13.7-20% at 16 weeks, 10.7-24% at 24 weeks and 21.8-34.8% at 1 year. IL-17 inhibitors achieved 23.3-44% at 12 weeks, 44.3-57.2% at 16 weeks, 39.7-67.5% at 24 weeks and 41.4-67.5% at 1 year. And the reported by IL-12/23 inhibitors were 12%/23.8% at 12 weeks, 32.7%/50% at 16 weeks, 44% at 24 weeks and 41.8%/56.3% at 1 year. PASI 100 response is scarcely commented in the CPGs.

CONCLUSIONS

PASI 100 response rate is an endpoint fundamentally restricted to research.

Burden of Psoriasis in Catalonia: Epidemiology, Associated Comorbidities, Health Care Utilization, and Sick Leave

BACKGROUND AND OBJECTIVES

Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave.

MATERIAL AND METHODS

We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012-2016).

RESULTS

The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%. The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications. Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases.

CONCLUSIONS

The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization.

Physical and Psychosocial Burden of Psoriatic Arthritis: Longitudinal Data From a Population-Based Study in Norway

OBJECTIVE

Psoriatic arthritis (PsA) can have a significant impact on health-related quality of life (HRQoL). Data on the timing of changes in the HRQoL of patients with PsA are limited. The present study was undertaken to explore associations between sleep disturbance, fatigue, pain, anxiety, depression, general health status, and satisfaction with life before and after a diagnosis of PsA compared to the general population.

METHODS

Patients diagnosed with PsA between the Nord-Trøndelag Health Study (HUNT2 [1995-1997] and HUNT3 [2006-2008]) surveys were compared to the general population. The adjusted odds ratio (OR_adj ) with 95% confidence interval (95% CI) was estimated at both time points.

RESULTS

Among 36,507 individuals participating in both the HUNT2 and HUNT3 surveys, 160 were diagnosed with PsA between the surveys. The prevalence of sleep disturbances and fatigue was higher in PsA patients after diagnosis compared to the general population (OR_adj 2.24 [95% CI 1.55-3.25] and OR_adj 1.94 [95% CI 1.27-2.98], respectively). The prevalence of pain and poor health status were higher in patients with PsA compared with the general population even before PsA was diagnosed (OR_adj 2.81 [95% CI 1.96-4.02] and OR_adj 3.08 [95% CI 2.19-4.35], respectively) and increased after diagnosis of PsA (OR_adj 12.87 [95% CI 6.27-26.40] and OR_adj 5.63 [95% CI 3.99-7.95], respectively). For anxiety, depression, and life satisfaction, patients who developed PsA were comparable to the general population both before and after the diagnosis of PsA.

CONCLUSION

Compared to the general population, PsA patients reported a higher prevalence of pain and poorer health status before diagnosis. Increased prevalence of sleep disturbances and fatigue in PsA patients was only found after the PsA diagnosis, and no differences between patients with PsA and the control group were found for anxiety and depression.

The effect of illness perception on life quality in psoriasis patients

Psoriasis is a chronic disease that has negative effects on quality of life. Understanding the illness perception of psoriasis is important for effective management of the disease and improving quality of life. The aim of this study was to determine the relationship between illness perception and quality of life in psoriasis patients. This cross-sectional study was performed with 306 patients who applied to a psoriasis outpatient clinic of a university hospital in Istanbul, Turkey. Data were collected using a sociodemographic characteristics and disease information form, the Dermatology Life Quality Index (DLQI), the Revised Illness Perception Questionnaire (IPQ-R) and the Psoriasis Area Severity Index (PASI) score. Data were analyzed using descriptive statistics, Kruskal-Wallis test and Mann-Whitney U test, Spearman correlation analysis, and multiple regression analysis. A positive relationship was found between scores on the DLQI and scores on the IPQ-R subscales of Illness identity, Consequences, Emotional representations, Time (cyclic), Personal attributions, External attributions, and Chance. A negative correlation was determined between DLQI scores and scores on the IPQ-R subscales of Treatment control and Illness coherence. Furthermore, there was a positive correlation between the PASI score and the DLQI scores and scores on the IPQ-R subscales of Consequences and Emotional representation. Multiple regression analysis showed that illness identity, PASI scores, treatment control, illness coherence, consequences, and personal attributions were significantly associated with quality of life (R2 = 0.365, p < 0.01). The quality of life of the psoriasis patients who associated their symptoms with the disease, who had a high PASI score, thought that they were adversely affected by the disease, and who saw personal attributions as the cause of the disease was negatively affected. The quality of life of patients who thought that their disease could be kept under control and who understood their disease was positively affected.

The Mediator Role of Body Image-Related Cognitive Fusion in the Relationship between Disease Severity Perception, Acceptance and Psoriasis Disability

Psoriasis is a long-term skin disorder without a cure, whose patients are particularly susceptible to mental health diseases. Using a sample of patients diagnosed with psoriasis, this study aimed to: (1) identify the clinical and positive psychological variables that contribute the most to psoriasis disability and (2) assess the mediator role of body image-related cognitive fusion in the relation between disease severity perception and acceptance and self-compassion, on one hand, and psoriasis disability on the other. This is an initial cross-sectional exploratory study, with 75 patients diagnosed with psoriasis (males 52%; mean age 54.99 ± 13.72) answering a sociodemographic and a clinical questionnaire, the Psoriasis Disability Index (PDI), the Cognitive Fusion Questionnaire-Body Image (CFQ-BI), the Acceptance and Action Questionnaire-II (AAQ-II), and the Self-Compassion Scale (SCS). Descriptive and inferential statistics were used to characterize and assess the measures and the final model used. Through path analysis and a hierarchical multiple linear regression, it was found that the variables that significantly contributed to psoriasis disability were years of education, impact on social life and body image, explaining 70% of the variance. Body image-related cognitive fusion was a significant mediator in the relationship between disease severity and acceptance, and psoriasis disability. The implications of this study are considered to be extremely relevant, since it will allow additional information to be provided to psoriasis patients, appropriated to their educational level, aiming to reduce distorted perceptions of disease severity and intervene in the ability to accept this specific and important chronic health condition.

Comparative study of life satisfaction among patients with psoriasis versus healthy comparison group: the explanatory role of body image and resource profiles

Purpose

The aim of the study was first to examine the heterogeneity of body image and resources, as described by the conservation of resources theory (COR), in a sample of psoriatic patients and explore whether heterogeneity within these variables explains the possible differences in levels of life satisfaction among the participants. Second, we aimed to investigate if life satisfaction level among the observed profiles of psoriatic patients, extracted on the basis of their body image and resources, differed from that of the healthy comparison group.

Methods

The sample consisted of 735 participants, including 355 adults with a medical diagnosis of psoriasis and 380 healthy adults recruited from a non-clinical general population. Participants filled the Satisfaction with Life Scale, the Multidimensional Body-Self Relations Questionnaire and the COR evaluation questionnaire.

Results

Latent profile analysis revealed four classes of psoriatic patients with different levels of resources and body image. The group with the highest level of resources and the most positive body image did not differ from the healthy comparison group regarding satisfaction with life. The group with the lowest level of resources and the most negative body image was characterized by the lowest satisfaction with life.

Conclusions

The results of our study may change the simplifying trend that highlights the traditionally very poor well-being of psoriatic patients. Moreover, the discovery of specific profiles of these patients, which differ with regard to psychological variables, can lead to rethinking contemporary forms of psychological counselling in psoriatic patients.

Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates

Introduction

Sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) may be influenced by skin and musculoskeletal manifestations. All of these in turn affect the psychosocial impact of disease. The objective was to explore the occurrence of sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) patients, and their correlates.

Methods

A broad data collection was performed in 137 Norwegian PsA outpatient clinic patients including demographics, disease activity measures for both skin and musculoskeletal involvement, and patient-reported outcome measures. Sleep disturbances and fatigue were defined present if the numeric rating scale (0–10) score was ≥ 5. Anxiety/depression was assessed using a questionnaire (1–3; 1 defined as no anxiety/depression). Descriptive statistics was applied, and associations were explored using univariate and adjusted linear regression analysis.

Results

The mean age was 52.3 years, PsA disease duration 8.8 years; 49.6% were men and 54.8% were currently employed/working. The prevalence of sleep disturbances was 38.0%, fatigue 44.5%, and anxiety/depression 38.0%. In adjusted analysis, pain, fatigue, and higher mHAQ were associated with sleep disturbances. Sleep disturbances, pain, and anxiety/depression were associated with fatigue, whereas only fatigue was associated with anxiety/depression.

Conclusions

The prevalence of sleep disturbances, fatigue, and anxiety/depression was frequently reported by PsA patients. No measures reflecting skin involvement or objective measures of musculoskeletal involvement were independently associated with sleep disturbances, fatigue, or anxiety/depression. Our data suggest that patients’ perceptions of musculoskeletal involvement (pain or mHAQ) play an important role causing sleep disturbances and fatigue, whereas fatigue in PsA patients is strongly associated with anxiety/depression.

The relationship between sleep disturbance, symptoms and daytime functioning in psoriasis: a prospective study integrating actigraphy and experience sampling methodology

OBJECTIVE/BACKGROUND

Sleep disturbance is common in individuals with psoriasis and appears to be related to both physical and psychological factors. We sought to examine whether psoriasis symptoms, night-time arousal and low mood predicted subsequent objective and self-reported sleep; and whether objective and self-reported sleep predicted next-day psoriasis symptoms and day-time functioning.

PARTICIPANTS/METHODS

A total of 19 individuals (Female: 11 [57.9%], median age: 39 years) with chronic plaque psoriasis and poor sleep quality (mean Pittsburgh Sleep Quality Index, PSQI = 9.11) participated. Momentary assessments of psoriasis symptoms, mood and daytime functioning were completed at five pseudo-random intervals each day for 15 days using time-stamped digital diary entry. Objective sleep was estimated using wrist-worn actigraphy. Self-reported sleep and night-time arousal were assessed each morning using validated measures.

RESULTS AND CONCLUSIONS

Two-level random intercept models showed that increased night-time arousal was associated with poorer diary-reported sleep. Neither self-reported nor objective sleep parameters were associated with daytime psoriasis symptoms in bi-directional analyses. Diary-reported sleep predicted next-day functioning, specifically sleepiness, concentration, and fatigue. Actigraphy-defined total sleep time predicted next-day fatigue. Night-time arousal is associated with poorer self-reported sleep in people with psoriasis, and sleep predicts next-day functioning. Contrary to our hypothesis, sleep disturbance does not appear to be associated with momentary assessments of psoriasis symptoms.

Influence of disease phase on embitterment and emotional dysregulation in psoriatic patients

This study aimed to evaluate the psychosocial differences between patients with psoriasis in different phases of the disease. Seventy-one patients in exacerbation and 83 in remission were evaluated regarding sociodemographic, clinical and psychological variables, on the premise that the visibility of lesions (exacerbation phase) may impact the emotional regulation and embitterment. A regression analysis was performed to identify the variables that contribute to explain embitterment: a diagnosis of anxiety and/or depression and psoriasis severity are the identified ones. The results point to higher values of emotional dysregulation and embitterment, as well as more critical clinical variables in patients with active disease, namely, alcohol and coffee consumption, smoking and less satisfaction with current treatment, more diagnoses and more family history of anxiety and depression, more psychology/psychiatry consultations and more use of anxiolytics and antidepressants. However, only the results referring to alcohol consumption and embitterment are significantly higher in subjects in the exacerbation phase of the disease. Particular clinical attention should be provided to patients in exacerbation phase regarding psychotherapeutic approach.

Impact of patient psoriasis on partner quality of life, sexuality and empathy feelings: a study in 183 couples

BACKGROUND

The impact of psoriasis on quality of life (QoL), sexuality and empathy requires better understanding in patient-partner relationships.

OBJECTIVES

To evaluate the influence of psoriasis on partner QoL, presence of sexual dysfunction (SDy) in couples and empathy in partners of psoriasis patients.

METHODS

A total of 183 adult psoriasis patients and their partners participated in this observational, cross-sectional and non-comparative study. Severity of psoriasis was measured using the Psoriasis Area and Severity Index. Patient QoL was assessed using the Dermatology Life Quality Index and the Short Form-12 (SF12). The impact of psoriasis on partner QoL was measured with the Family Pso and the SF12. Presence of SDy and empathy in partners were assessed using the Family Pso.

RESULTS

Overall, 49.7% of the patients had moderate-to-severe psoriasis. Patient psoriasis severity and patient QoL were correlated with partner psychological distress. The largest QoL impairment was observed in female patients with moderate-to-severe psoriasis. The stronger QoL alteration observed in female psoriasis patients, compared to their partners, was not observed in male psoriasis patients vs. their partners. There was no relationship between partner QoL and patient age and duration of psoriasis. Most patients, but less than half of the partners, reported SDy with age being a being a significantly more important impacting factor than disease severity. Both psoriasis clinical severity and/or a significant impact on QoL were associated factors for SDy in male partners of psoriasis women, but not in female partners of psoriatic men. Reporting empathy was higher among young male partners of psoriasis patients. In both male and female partners, patient psoriasis clinical severity was not associated with empathy.

CONCLUSIONS

Psoriasis impact on patient-partner QoL, sexuality and empathy should be considered more thoroughly by dermatologists when formulating treatment plans and making treatment decisions.

Assessing the relative efficacy of interleukin-17 and interleukin-23 targeted treatments for moderate-to-severe plaque psoriasis: A systematic review and network meta-analysis of PASI response

INTRODUCTION

New generation biologics, including interleukin (IL)-17 and IL-23 inhibitors, have delivered higher rates of skin clearance than older treatments in head-to-head studies. However, studies comparing these new biologics directly to one another are limited.

OBJECTIVES

To compare the short-term efficacy of available (or imminently available) biologic and non-biologic systemic therapies for treating patients with moderate-to-severe plaque psoriasis.

METHODS

A systematic review was undertaken to identify randomised controlled trials evaluating biologic treatments, apremilast and dimethyl fumarate. MEDLINE, MEDLINE In-Process, Embase and the Cochrane Library were searched from the 1st January 2000 to 22nd November 2018. A Bayesian network meta-analysis (NMA) using a random-effects multinomial likelihood model with probit link and meta-regression to adjust for cross-trial variation in placebo responses compared the efficacy of interventions at inducing different levels of Psoriasis Area and Severity Index (PASI) response during the induction period. A range of sensitivity analyses was undertaken.

RESULTS

Seventy-seven trials (34,816 patients) were included in the NMA. The base-case analysis showed that all active treatments were superior to placebo. IL-17 inhibitors, guselkumab and risankizumab were found to be more efficacious than tildrakizumab, ustekinumab, all TNF inhibitors and non-biologic systemic treatments at inducing all levels of PASI response. In addition, brodalumab, ixekizumab and risankizumab were significantly more efficacious than secukinumab; no significant difference was found in the comparison with guselkumab. The greatest benefit of brodalumab, ixekizumab, guselkumab, and risankizumab was seen for PASI 90 and PASI 100 response. Results were consistent across all analyses.

CONCLUSIONS

In the NMA brodalumab, ixekizumab, risankizumab and guselkumab showed the highest levels of short-term efficacy. There were differences in efficacy between treatments within the same class. Longer-term analyses are needed to understand differences between these drugs beyond induction in what is a life-long condition.

Datura Metel L. Ameliorates Imiquimod-Induced Psoriasis-Like Dermatitis and Inhibits Inflammatory Cytokines Production through TLR7/8-MyD88-NF-κB-NLRP3 Inflammasome Pathway

Background: Psoriasis is a chronic, immune-mediated inflammatory skin disease, and the inflammatory response plays an important role in its development and progression. Datura metel L. is a traditional Chinese medicine that exhibited a significant therapeutic effect on psoriasis in our previous study due to its remarkable anti-inflammatory effect. Meanwhile, the mechanism underlying its effects on psoriasis is still unclear. Methods: An imiquimod-induced psoriasis-like dermatitis mouse model was constructed to evaluate the protective effect of the effective part of Datura metel L. (EPD), which was verified by evaluations of the Psoriasis Area and Severity Index (PASI) score. Hematoxylin and eosin (H&E) staining, immunohistochemical examination, enzyme-linked immunosorbent assay (ELISA), and Western blot were used to measure the inflammatory cytokines and the protein expression associated with the Toll-like receptor 7– myeloid differentiation primary response gene 88–nuclear Factor-κB–nucleotide-binding oligomerization domain (Nod)-like receptor family pyrin domain-containing 3 (TLR7/8–MyD88–NF-κB–NLRP3) inflammasome pathway. Results: EPD significantly decreased the PASI, reduced epidermal thickness, and decreased the proliferation and differentiation of epidermal cells in psoriasis-like dermatitis C57BL/6 mice induced by imiquimod (IMQ). Furthermore, EPD reduced the infiltration of CD3+ cells to psoriatic lesions, as well as ameliorated the elevations of intercellular adhesion molecule 1 (ICAM-1) and inhibited the production of imiquimod-induced inflammatory cytokines, including IL-1β, IL-2, IL-6, IL-10, IL-12, IL-17, IL-22, IL-23, tumor necrosis factor-α (TNF-α), monocyte chemotactic protein 1 (MCP-1), and interferon-γ (IFN-γ). Besides, EPD decreased the imiquimod-induced expression levels of TLR7, TLR8, TRAF6, MyD88, p-IKKα, p-IKBα, p-NF-κB, NLRP3, apoptosis-associated speck-like protein contained a caspase recruitment domain (ASC), cysteinyl aspartate specific proteinase 1 (caspase-1), and IL-1β. Conclusion: This study demonstrated that EPD exhibited a protective effect on an imiquimod-induced psoriasis mice model by inhibiting the inflammatory response, which might be ascribed to the inhibition of the TLR7/8–MyD88–NF-κb–NLRP3 inflammasome pathway.

Quality of life and contact with healthcare systems among patients with psoriasis and psoriatic arthritis: results from the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP)

Psoriasis (skin psoriasis, PsO) is a chronic inflammatory condition. In about one-third of cases, the joints are affected (psoriatic arthritis, PsA). Both conditions, especially PsA, profoundly impact patients’ health-related quality of life (HRQoL). To describe the impact of psoriasis on HRQoL and patients’ contact with the healthcare system in Sweden, Denmark, and Norway, the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP) asked 22,050 adults randomly selected in Sweden, Denmark and Norway if they had psoriasis. 1264 individuals who reported physician-diagnosed PsO/PsA were invited to the full survey; 1221 responded (74.6% diagnosed with PsO alone; 25.4% with PsA ± PsO). Respondents with PsA most frequently consulted a rheumatologist; however, 14.3% had never seen a rheumatologist. Respondents with PsO alone most frequently consulted a general practitioner and 10.7% had never seen a dermatologist (although those with severe symptoms visited dermatologists more often). Negative impacts on HRQoL were reported by 38.1% of respondents with PsO [mostly limitations on clothing (22.6%), sleep disorders (16%), and depression/anxiety (16%)] and by 73% of respondents with PsA [mostly limitations on clothing (41.8%), sports/leisure (44.0%), or daily routine (45.1%) and sleeping disorders]. Absence from work/education was more common with PsA ± PsO (51.9%) than PsO alone (15.1%). In this survey in Sweden, Denmark, and Norway, the impact of psoriasis on the respondents’ HRQoL was profound and was greater for PsA than for PsO, as was sickness absence. Sleeping disorders and depression were common and should not be overlooked.

Cause-specific mortality in patients with psoriasis and psoriatic arthritis

BACKGROUND

There are limited data regarding causes of mortality in patients with psoriasis or psoriatic arthritis (PsA).

OBJECTIVES

This retrospective cohort study evaluated the risk and leading causes of mortality in patients with psoriasis or PsA.

METHODS

Individuals with a hospital-based diagnosis of PsA or psoriasis were identified using the Danish National Patient Registry. Matched control individuals were identified from the general population. The main outcome measures were risk of death and cause-specific mortality in patients with psoriasis or PsA.

RESULTS

Death rates per 1000 patient-years (with 95% confidence intervals) vs. controls were 22·3 (19·7-24·9) vs. 13·9 (11·8-16·0) for patients with psoriasis and 10·8 (8·9-12·8) vs. 11·6 (9·6-13·6) for patients with PsA. Survival, according to stratified hazard ratios (HRs), was significantly lower in patients with psoriasis than in controls (HR 1·74, P < 0·001), but not in patients with PsA (HR 1·06, P = 0·19). Significantly increased risk of death was observed in patients with psoriasis vs. controls due to a number of causes; the highest risks were observed for diseases of the digestive system; endocrine, nutritional and metabolic diseases; and certain infectious and parasitic diseases (HRs 3·61, 3·02 and 2·71, respectively). In patients with PsA, increased mortality was observed only for certain infectious and parasitic diseases (HR 2·80) and diseases of the respiratory system (HR 1·46). Patients with psoriasis died at a younger age than controls (mean age 71·0 vs. 74·5 years, P < 0·001).

CONCLUSIONS

Patients with severe psoriasis have increased mortality risk compared with matched controls, due to a number of causes. Evidence to support an increased risk for patients with PsA was less convincing.

A cross-sectional study in young adults with psoriasis: potential determining factors in quality of life, life course and work productivity

BACKGROUND

Psoriasis can have a substantial impact on health-related quality of life (HRQoL), life course, and work productivity. Young adulthood is a critical, sensitive period of development that includes major life changing decisions. The impact of psoriasis on this vulnerable population is yet unknown.

OBJECTIVES

To assess QoL, life course, and work productivity in young adults with psoriasis and identify characteristics influencing these patient-reported outcomes (PRO).

METHODS

An explorative, cross-sectional study was performed in psoriasis patients aged 18-30 years. Individuals completed a set of questionnaires regarding their health status (DLQI, SF-36, EQ-5D), achievement of developmental milestones (COLQ), and work productivity (WPAI-PSO, PRODISQ).

RESULTS

Seventy-five patients (22 males, 53 females; median age [IQR], 21.0 [8.0]). Median PASI and BSA, respectively, were 4.4 [4.9] and 4.5 [8.4]. Young adults experienced feelings of embarrassment, impairments in physical health and work productivity, and difficulties in social development. Patients with more severe psoriasis, longer disease duration, higher body mass index (BMI), female patients and patients closer to their thirties tended to be more affected.

CONCLUSION

In the young adult psoriasis population, substantial QoL impairments were found. Female patients, patients with high BMI, or long disease duration in particular tended to experience more difficulties. These exploratory findings indicate the need for further studies in young adults to detect potential clinical predictors for severe HRQoL impairments.

The impact of psoriasis on professional life: PsoPRO, a French national survey

BACKGROUND

The physical, social and mental burden of psoriasis is well known, but its occupational impact has been less investigated.

OBJECTIVE

To assess the impact of psoriasis on the working life of patients compared with the general population.

METHODS

A national survey compared people with and without psoriasis using online questionnaires. In addition to the demographic, medical and professional characteristics, data on recent absenteeism and presenteeism were captured using the validated WPAI-PSO questionnaire.

RESULTS

The patient sample comprised 714 with psoriasis (PsO), including 81 treated with systemic therapies (PsoST), and 84 with associated psoriatic arthritis (PsO + PsA). The control sample comprised 604 active subjects representative of the French population. Compared to controls, the impact of the disease on working life was no greater in PsO patients. Conversely, unemployment within the past 5 years and mean number of sick leaves within the previous year were more frequent in PsO + PsA. In patients with active psoriasis skin lesions, all aspects of the WPAI questionnaire were negatively impacted in PsoST and PsO + PsA patients, but not in PsO patients: Levels of absenteeism were 3.3% in controls, 5.6% in PsO (NS), 8.3% in PsoST (P < 0.05) and 13.0% in Ps0 + PsA (P < 0.05); impairment in presenteeism reached 27.0%, 21.2% (NS), 43.5% (P < 0.05) and 53.2% (P < 0.05), respectively, while overall work impairment was 27.9%, 22.2% (NS), 46.3% (P < 0.05) and 57.6% (P < 0.05), respectively. Nevertheless, a higher proportion of PsoST and PsO + PsA patients reported that work was more important than any other activity in their life.

CONCLUSION

The occupational impact of psoriasis is important and significant in patients who receive systemic therapy or have concurrent PsA but minimal or absent in other psoriasis patients. The findings show that psoriasis patients have a high level of motivation to work.

Cognitive impairment in patients with psoriasis: A matched case-control study

BACKGROUND

In the past decade, a few studies have suggested that psoriasis could be associated with the presence of mild cognitive deficits.

OBJECTIVES

The aim of the present matched case-control study was to investigate several cognitive domains (executive functions, verbal memory, attention, and language) in a sample of outpatients with psoriasis. We also investigated whether cognitive impairment was associated with poor health-related quality of life (HRQoL) in patients with psoriasis.

METHODS

Fifty adult outpatients and 50 age- and sex-matched healthy controls were administered a battery of neuropsychological tests investigating major cognitive domains, psychopathology (anxiety and depression), alexithymia, and HRQoL.

RESULTS

At the bivariate level, psoriasis patients (compared to healthy controls) performed worse on most of the neuropsychological tests, and they also reported more anxiety and depressive symptoms, higher scores for alexithymia, and worse physical and mental health. At the multivariate level, cognitive performance was independently associated with psoriasis even when controlling for psychopathology and alexithymia.

CONCLUSIONS

Patients with psoriasis show impaired cognitive performance, high levels of anxiety and depression, and impaired quality of life. Based on the current results, clinicians should assess the presence of psychological symptoms in their patients and evaluate whether the presence of cognitive deficits is limiting the patients' ability to cope with the disease.

The comparative efficacy of brodalumab in patients with moderate-to-severe psoriasis: a systematic literature review and network meta-analysis

PURPOSE

To evaluate the relative efficacy of brodalumab compared with approved biologic therapies and apremilast for moderate-to-severe psoriasis.

METHODS

We searched MEDLINE, Embase, and Cochrane for randomized controlled trials reporting induction phase responses. The primary analysis examined the proportion of patients achieving Psoriasis Area Severity Index (PASI) 50, 75, 90, or 100 responses using a random-effects Bayesian multinomial likelihood model with probit link, with and without adjustment for variation in study-level placebo responses.

RESULTS

A total of 54 studies were included. Based on PASI 100 response, the most efficacious therapies were brodalumab 210 mg every two weeks (Q2W) and ixekizumab. Brodalumab 210 mg Q2W was significantly more efficacious than adalimumab, apremilast, brodalumab 140 mg Q2W, etanercept, infliximab, secukinumab, and ustekinumab. Results were consistent for PASI 50, 75, and 90 outcomes and all sensitivity analyses.

CONCLUSIONS

Our findings are consistent with pivotal trials which indicate that high levels of complete clearance can be achieved with brodalumab. Based on existing evidence, induction-phase efficacy of brodalumab is similar to ixekizumab and superior to other approved therapies, including anti-TNFs, apremilast, secukinumab, and ustekinumab.

A detailed analysis of 'not relevant' responses on the DLQI in psoriasis: potential biases in treatment decisions

BACKGROUND

Dermatology Life Quality Index (DLQI) is the most common health-related quality of life measure in dermatology that is widely used in treatment guidelines for psoriasis. Eight of the 10 questions of the DLQI offer a 'not relevant' response (NRR) option that is scored as the item had no impact on patients' life at all.

OBJECTIVE

To explore the occurrence of NRRs on the DLQI in psoriasis patients and to examine the effect of several socio-demographic and clinical factors on giving NRRs.

METHODS

Data were obtained from two cross-sectional surveys among psoriasis patients at two academic dermatology clinics in Hungary. Health-related quality of life was measured by employing DLQI and EQ-5D-3L, while disease severity was graded by Psoriasis Area and Severity Index (PASI). Multivariate logistic regression was applied to determine the predictors of providing NRRs.

RESULTS

Mean age of the 428 patients was 49 years, and 65% were males. Mean PASI, DLQI and EQ-5D-3L index scores were 8.4 ± 9.5, 6.8 ± 7.4 and 0.74 ± 0.28, respectively. Overall, 38.8% of the patients had at least one NRR: 19.6% (one), 11.5% (two), 5.1% (three) and 2.6% (more than three). Most NRRs occurred in sport, sexual difficulties and working/studying items of the DLQI (28.4%, 16.4% and 14.0%, respectively). Female gender (OR 1.65; 95% CI 1.04-2.61), older age (OR 1.05; 95% CI 1.03-1.07) and higher PASI score (OR 1.03; 95% CI 1.01-1.06) were associated with providing more NRRs, whereas highly educated patients (OR 0.34; 95% CI 0.16-0.72) and those with a full-time job (OR 0.47; 95% CI 0.29-0.77) less frequently tended to tick NRRs.

CONCLUSION

The high rate of psoriasis patients with NRRs, especially among women, less educated and elderly patients, indicates a content validity problem of the measure. A reconsideration of the use of the DLQI for medical and financial decision-making in psoriasis patients is suggested.

Risk and predictors of psoriasis in patients with breast cancer: a Swedish population-based cohort study

BACKGROUND

The risk of psoriasis in patients with breast cancer is largely unknown, as available evidence is limited to case findings. We systematically examined the incidence and risk factors of psoriasis in patients with breast cancer.

METHODS

A Swedish nationwide cohort of 56,235 breast cancer patients (2001-2012) was compared to 280,854 matched reference individuals from the general population to estimate the incidence and hazard ratio (HR) of new-onset psoriasis. We also calculated HRs for psoriasis according to treatment, genetic, and lifestyle factors in a regional cohort of 8987 patients.

RESULTS

In the nationwide cohort, 599 patients with breast cancer were diagnosed with psoriasis during a median follow-up of 5.1 years compared to 2795 cases in the matched reference individuals. This corresponded to an incidence rate of 1.9/1000 person-years in breast cancer patients vs. 1.7/1000 person-years in matched reference individuals. Breast cancer patients were at an increased risk of psoriasis (HR = 1.17; 95% confidence interval (CI) = 1.07-1.28), especially its most common subtype (psoriasis vulgaris; HR = 1.33; 95% CI = 1.17-1.52). The risk of psoriasis vulgaris was highest shortly after diagnosis but remained increased up to 12 years. Treatment-specific analyses indicated a higher risk of psoriasis in patients treated with radiotherapy (HR = 2.44; 95% CI = 1.44-4.12) and mastectomy (HR = 1.54, 95% CI = 1.03-2.31). Apart from treatment-specific effects, we identified genetic predisposition, obesity, and smoking as independent risk factors for psoriasis in breast cancer patients.

CONCLUSIONS

The incidence of psoriasis is slightly elevated among patients with breast cancer, with treatment, lifestyle, and genetic factors defining the individual risk profile.

Health-related quality of life and its association with alexithymia and difficulties in emotion regulation in patients with psoriasis

BACKGROUND

Health-related quality of life (HRQoL) in psoriasis patients could be negatively affected by medical (e.g., obesity) and psychological (e.g., depression, anxiety, and alexithymia) conditions the presence of which suggests difficulties in understanding and regulating inner states and emotions. Thus, the aim of this study was to investigate HRQoL and its association with obesity and difficulties in understanding and regulating inner states and emotions in patients with psoriasis. A second objective was to examine whether the presence of difficulties in understanding and regulating inner states and emotions may mediate the association between psoriasis and poor HRQoL.

METHOD

One hundred adult outpatients and 97 healthy controls were administered a checklist assessing major socio-demographic variables, and measures of HRQoL, difficulties in emotion regulation, alexithymia, anxiety, depression, and food craving.

RESULTS

Psoriasis patients (compared to controls) reported more frequently obesity, alexithymia, anxiety, depression and food craving, and reported lower scores on the mental and physical components of HRQoL. A mediation model, with mental health as the dependent variable, indicated significant direct and indirect (through BMI, difficulties in emotion regulation, anxiety, depression, and food craving) effects of psoriasis on the quality of life, so that psoriasis was associated with worse mental health. A second mediation model with physical health as dependent variable indicated only a significant indirect effect (through BMI and depression) of psoriasis on the quality of life.

CONCLUSIONS

Psoriasis is characterized by poor HRQoL and the presence of difficulties in understanding and regulating inner states and emotions. In patients with psoriasis the possible influence of food craving on abnormal eating habits should be carefully assessed.

Adherence, satisfaction and preferences for treatment in patients with psoriasis in the European Union: a systematic review of the literature

BACKGROUND AND OBJECTIVE

Adherence to treatment in patients with psoriasis is often poor. An investigation of patient preferences and satisfaction with treatment may be important, based on the expected correlation with therapy compliance. This paper aims to examine and describe the current literature on patient preferences, satisfaction and adherence to treatment for psoriasis in the European Union (EU).

METHODS

Electronic searches were conducted using PubMed, ISI Web of Knowledge, Scopus, Spanish databases and Google Scholar. European studies published in English or Spanish between January 1, 2009 and December 31, 2014 regarding patient-reported outcomes in psoriatic patients were included. Studies conducted in non-EU countries, letters to the editor, editorials, experts' opinions, case studies, congress proceedings, publications that did not differentiate between patients with psoriasis and psoriatic arthritis or studies related to specific treatment were excluded.

RESULTS

A total of 1,769 titles were identified, of which 1,636 were excluded as they were duplicates or did not provide any relevant information. After a full-text reading and application of the inclusion/exclusion criteria, 46 publications were included. This paper will describe publications on adherence (n=4), preferences (n=5) and satisfaction with treatment (n=7). Results related to health-related quality of life articles (n=30) have been published elsewhere. Adherence rates are generally low in psoriasis patients regardless of the type of treatment, severity of disease or methods used to measure adherence. Biologic therapy is associated with greater clinical improvement. There is a direct association between physician recommendations, patient preferences and several domains of treatment satisfaction.

CONCLUSION

The results of this review support the conclusion that adherence rates in patients with psoriasis are suboptimal and highlight the need to improve patient compliance and satisfaction with treatment. Patients' preferences should be taken into account in the treatment decision-making process in order to improve patients' clinical outcomes by ensuring satisfaction and adherence.