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Strober B, Duffin KC, Lebwohl M, Sima A, Janak J, Patel M, Photowala H, Garg V, Bagel J. Impact of psoriasis disease severity and special area involvement on patient-reported outcomes in the real world: an analysis from the CorEvitas psoriasis registry. J DERMATOL TREAT 2024; 35:2287401. [PMID: 38073528 DOI: 10.1080/09546634.2023.2287401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND The impact of psoriasis in special areas (i.e., scalp, nails, palms, soles, genitals) on patient physical functioning, health-related quality of life (HRQoL), and work abilities has not been fully characterized. We assessed associations between disease severity and special area involvement in psoriasis symptoms, HRQoL, and work/activity impairment. METHODS Patients with psoriasis from the CorEvitas Psoriasis Registry who initiated systemic treatment between 04/2015-06/2020 were included. Outcomes were change from baseline in psoriasis symptoms, Dermatology Life Quality Index (DLQI), and work/activity impairment at 6 months stratified by baseline disease severity and special area involvement. RESULTS Among 2620 patients, increasing disease severity was associated with worsening patient-reported outcomes. Patients with (46.0%; N = 1205) versus without (54.0%; N = 1415) psoriasis in special areas reported greater HRQoL and work/activity impairment. Over 6 months, patients with unchanged or worsening disease severity had reduced HRQoL and increased symptom severity; incremental increases in patient HRQoL and decreases in symptom severity were associated with improved disease severity. CONCLUSIONS Higher disease severity and special area involvement was associated with worse outcomes and impaired work abilities. These data highlight the significant impact that adequate treatment of severe psoriasis and/or special area involvement may have on patient HRQoL and function.
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Affiliation(s)
- Bruce Strober
- Yale University, New Haven, CT, and Central Connecticut Dermatology, Cromwell, CT, USA
| | | | - Mark Lebwohl
- Icahan School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, NJ, USA
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2
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Veronese F, Esposto E, Airoldi C, Gramaglia C, Bestagini L, Zavattaro E, Zeppegno P, Savoia P. A prospective randomized controlled trial of Psychodermatology on the efficacy of Rilastil Difesa Sterile® cream in the hand eczema of healthcare workers during the COVID-19 pandemic. J DERMATOL TREAT 2023; 34:2245080. [PMID: 37558217 DOI: 10.1080/09546634.2023.2245080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
Hand eczema is one of the most frequent dermatological diseases, with an incidence increased during the COVID-19 pandemic. The impact on life quality is considerable, giving rise to the need for a psycho-dermatological approach. This is a Randomized Control Trial (RCT) evaluating, either by the dermatological or psychological point of view, the effectiveness of an emollient and rehydrating topical product (Rilastil Difesa Sterile® cream) versus a standard treatment (i.e. moisturizing basic cream) in a group of 51 healthcare workers suffering from hand eczema during the COVID-19 pandemic. The enrolled subjects were randomized into a treatment or a control arm, treated for 8 weeks, and monitored through a clinical score (HECSI) and questionnaires evaluating the impact of the pathology and treatment on quality of life (DLQI and QOLHEQ). A psychometric evaluation was performed using the SCL-90 R, OCI-R, and CPDI scales. Our data, despite not reaching the statistical significance, demonstrated that both the clinical and psychological scores decreased mostly in patients treated with Rilastil Difesa Sterile® cream when compared to those treated with simple topical emollients. Moreover, we observed a high level of psychic suffering in dermatological patients and a parallel change in dermatological and psychological indicators, thus confirming their connection.
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Affiliation(s)
| | - Elia Esposto
- SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Lucia Bestagini
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elisa Zavattaro
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paola Savoia
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
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3
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Gonzalez-Cantero A, Constantin MM, Dattola A, Hillary T, Kleyn E, Magnolo N. Gender perspective in psoriasis: a scoping review and proposal of strategies for improved clinical practice by European dermatologists. Int J Womens Dermatol 2023; 9:e112. [PMID: 37915402 PMCID: PMC10615520 DOI: 10.1097/jw9.0000000000000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/26/2023] [Indexed: 11/03/2023] Open
Abstract
Background The prevalence of psoriasis is similar between men and women; however, evidence exists of sex- and gender-related differences in disease expression, impact, coping, and needs of patients with psoriasis. These differences are essential and should be considered in clinical practice and research. Objective To compile available evidence on sex- and gender-related differences in psoriasis, identify the most critical gaps in clinical practice and research, and use it to propose strategies for improved clinical practice. Methods Six European dermatologists selected the topics to consider according to their relevance in the dermatology setting with the support of methodologists. Evidence on sex- and gender-related differences was obtained by a scoping review based on search strategies in Medline and Cochrane Library from inception to October 2021 using the following terms: arthritis, psoriatic, psoriasis, gender, and sex. The panel discussed the results and proposed strategies by consensus. Results The scoping review identified broad themes: (1) clinical expression, (2) severity and patient-reported outcomes, (3) psychosocial impact, (4) access to treatments and propensity to treat, (5) comorbidities, and (6) treatment effect. The strategies are based on these broad themes. Limitations No risk of bias assessment was done due to the scoping nature of the review. Conclusion This review offers insights into gender differences in psoriasis, providing a foundation for improving clinical practice and patient outcomes.
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Affiliation(s)
- Alvaro Gonzalez-Cantero
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - María Magdalena Constantin
- Departments of Dermatologists, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Annunziata Dattola
- Department of Dermatology, University of Rome “Tor Vergata,” Rome, Italy
| | - Tom Hillary
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Elise Kleyn
- Brain-Skin Unit, The Dermatology Centre, Departments of Dermatologists, University of Manchester and Salford Royal Hospital, Manchester, UK
| | - Nina Magnolo
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
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Foley P, Gebauer K, Sullivan J, McMeniman E, Shumack S, Ng J, James A, Rawlin M, Sidhu S, Tilakaratne D, Turner M, Radulski B, Nash P, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Adult patients. Australas J Dermatol 2023; 64:476-487. [PMID: 37501636 DOI: 10.1111/ajd.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Over the last decade, the treatment landscape for moderate-severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate-severe psoriasis. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high-impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy. CONCLUSION The ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate-severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- Fremantle Dermatology, Fremantle, Western Australia, Australia
- The University of Western Australia, Nedlands, Western Australia, Australia
| | - John Sullivan
- Kareena Private Hospital, Ramsay Surgical Centre, Miranda, New South Wales, Australia
- Kingsway Dermatology & Aesthetics, Miranda, New South Wales, Australia
| | - Erin McMeniman
- Dermatology Research Centre, Princess Alexandra Hospital Southside Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan Ng
- Hobart Medical Specialists, Hobart, Tasmania, Australia
| | - Amelia James
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Morton Rawlin
- General Practitioner, Lower Templestowe, Victoria, Australia
| | - Shireen Sidhu
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Dev Tilakaratne
- Department of Dermatology, Royal Darwin Hospital, Tiwi, Northwest Territories, Australia
- Darwin Dermatology, Tiwi, Northwest Territories, Australia
| | | | - Barbara Radulski
- CNC Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Nash
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Rheumatology Research Unit, Sunshine Coast, Queensland, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Jankowiak B, Krajewska-Kułak E, Jakoniuk M, Khvorik DF. Stigmatization among Patients with Plaque Psoriasis. J Clin Med 2023; 12:6425. [PMID: 37835068 PMCID: PMC10573936 DOI: 10.3390/jcm12196425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
The aim of the study was to analyze the level of stigmatization among patients with plaque psoriasis according to their demographic and clinical characteristics. The study included 122 patients who completed the 6-item and 33-item Feelings of Stigmatization Questionnaire and a sociodemographic survey. The analysis of the 6-item Stigmatization Scale showed a mean stigmatization score of 6.4 points. (Me = 6; s = 3.7); the mean score for the 33-item scale was 81.3 points (Me = 79.5; s = 19.9). Female patients felt stigmatized more often than males. Respondents living in the countryside had a stronger sense of stigmatization in the Sensitivity to Others' Attitudes (p = 0.0238) and Secretiveness (p = 0.0234) domains. The presence of psoriatic lesions across the entire body was the only explanatory variable significantly determining the level of stigmatization in the Positive Attitudes domain, either through the main effect or through the interaction with the patient sex. A highly significant difference was found for the feeling of being flawed domain (p = 0.044), with a mean score of 13.4 points. The issue of stigmatization in psoriasis deserves more attention, as the analysis of this problem may provide a better insight into the effect of the disease on the patient's condition, not merely in the context of its clinical manifestation.
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Affiliation(s)
- Barbara Jankowiak
- Department of Integrated Medical Care, Medical University of Bialystok, 15-096 Białystok, Poland;
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Medical University of Bialystok, 15-096 Białystok, Poland;
| | - Marta Jakoniuk
- Department of Invasive Neurology, Medical University of Białystok, 15-096 Białystok, Poland;
| | - Dzmitry F. Khvorik
- Department of Dermatovenerology, Medical University of Grodno, 230009 Grodno, Belarus;
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Abu Alqam R, Obaid H, Aljondi R, Alsulymani B, Aljohani R, Aleissa SM, Baabdullah A, Zimmo BS, Abduljabbar MH, Hariri J. The Extent of Misconceptions, Negative Prejudices, and Discriminatory Behaviors Toward Psoriasis Patients: A Cross-Sectional Survey Study Among the Population of Jeddah, Saudi Arabia. Cureus 2023; 15:e41678. [PMID: 37575830 PMCID: PMC10413171 DOI: 10.7759/cureus.41678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Psoriasis is a chronic inflammatory disease that affects around 2% of the population. The lives of psoriasis patients are greatly impacted by stigma and social exclusion, regardless of the severity of the condition. This is the first study of its kind to be conducted in Saudi Arabia. This study aimed to assess peoples' psoriasis-related misconceptions, negative prejudice, and discriminatory behaviors. Methodology A self-administered Google Forms survey was distributed between January and February 2023. The survey was conducted among residents of Jeddah, Saudi Arabia who were enrolled randomly via social media. We aimed to investigate their perception and awareness related to psoriasis, as well as how varying educational levels, age groups, and genders affected these variables. Results In total, 803 individuals participated in the survey. Results showed that 19.9% of the participants did not know about psoriasis. Only 5.1% of respondents stated that they were well knowledgeable about psoriasis. Moreover, psoriasis was more frequently perceived as a communicable disease by people in the age group of 18-29 years (p = 0.000). Surprisingly, only 43.5% of the participants reported that they would shake hands with someone with psoriasis without hesitation. Additionally, 40.7% of the participants were aware that psoriasis requires lifelong treatment. Moreover, the belief that psoriasis does not require lifelong therapy was more prevalent among university graduates (p = 0.000). Conclusions This study found that the residents of Jeddah need further education on skin disorders, in general, and psoriasis, in particular. Future studies should be conducted utilizing various approaches, with a greater emphasis on certain groups of people who engage physically with psoriasis patients.
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Affiliation(s)
- Rakan Abu Alqam
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Haya Obaid
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Raghad Aljondi
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Badr Alsulymani
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Raghad Aljohani
- Medical School, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Saud M Aleissa
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
- Dermatology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ahmed Baabdullah
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
- Dermatology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Bader S Zimmo
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
- Dermatology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohammed H Abduljabbar
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
- Dermatology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Jehad Hariri
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
- Dermatology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Komine M, Kim H, Yi J, Zhong Y, Sakai Y, Crawford B, Habiro K, Hikichi Y, Feldman SR. A discrete choice experiment on oral and injection treatment preferences among moderate-to-severe psoriasis patients in Japan. J Dermatol 2023. [PMID: 36808765 DOI: 10.1111/1346-8138.16746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023]
Abstract
Long-term psoriasis (PsO) management remains challenging. With growing variation in treatment efficacy, cost, and modes of administration, patient preferences for different treatment characteristics are not well understood. A discrete choice experiment (DCE), informed by qualitative patient interviews, was conducted to assess patient preferences for different attributes of PsO treatments; 222 adult patients with moderate-to-severe PsO receiving systemic therapy participated in the DCE web survey. Better long-term efficacy and lower cost were preferred (preference weights p < 0.05). Long-term efficacy had the highest relative importance (RI) and mode of administration was as important as the outcome attributes (efficacy and safety). Patients also preferred oral to injectable administration. In subgroup analyses by disease severity, residence, psoriatic arthritis as a comorbidity, and gender, the trends for each subgroup were the same as the overall population although the extent of RI for administration mode varied. Mode of administration was more important for patients with moderate versus severe disease, or rural versus urban residence. This DCE utilized attributes related to both oral and injectable treatment as well as a broad study population of systemic treatment users. Preferences were further stratified by patient characteristics to explore trends in different subgroups. Understanding the RI of treatment attributes and the attribute trade-offs acceptable to patients helps inform moderate-to-severe PsO systemic treatments decisions.
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Affiliation(s)
- Mayumi Komine
- Jichi Medical University Hospital, Tochigi, Shimotsuke, Japan
| | | | | | | | | | | | | | | | - Steven R Feldman
- Atrium Health Wake Forest Baptist, North Carolina, Winston-Salem, USA
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Richard MA, Saint Aroman M, Baissac C, Merhand S, Aubert R, Audouze A, Legrand C, Beausillon C, Carre M, Raynal H, Bergqvist C, Taieb C, Cribier B. Burden of visible [face and hands] skin diseases: Results from a large international survey. Ann Dermatol Venereol 2023:S0151-9638(22)00122-3. [PMID: 36653227 DOI: 10.1016/j.annder.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 10/08/2022] [Accepted: 11/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND While numerous surveys over the last decade have evaluated the burden of skin diseases, none have focused on the specific impact of disease-location on the hands and face. AIM The purpose of our study was to evaluate the burden of 8 skin diseases on the multidimensional aspects of subjects' daily lives in respect to their location on visible body areas (face or hands) versus non-visible areas. METHODS This was a population-based study in a representative sample of the Canadian, Chinese, Italian, Spanish, German and French populations, aged over 18 years using the proportional quota sampling method. All participants were asked (i) to complete a specific questionnaire including socio-demographic characteristics, (ii) to declare if they had a skin disease. All respondents with a skin disease were asked (iii) to specify the respective disease locations (hands, face, body) and (iv) to complete the DLQI questionnaire. Respondents with 8 selected skin diseases were asked (v) to complete a questionnaire evaluating the impact of the skin disease on their daily life, including their professional activity, social relations, emotional and intimate life, leisure, sports activities and perceived stigma. RESULTS A total of 13,138 adult participants responded to the questionnaire, of whom 26.2 % (n = 3,450) had skin diseases, and 23.4 % (n = 3,072) reported having one of the 8 selected skin diseases. Fifty-three percent were women and the mean age was 39.6 ± 15.5 years. The QoL was mostly impaired when the visible localization was solely on the hands as compared with the face (38 % had a DLQI > 10 versus 22 % respectively). More subjects with a visible localization on the hands reported felt-stigma, having difficulty falling asleep and felt that their sex life had been affected. CONCLUSION Special attention should be given to patients with skin disease on the hands and face as they are at higher risk of social exclusion and lower quality of life.
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Affiliation(s)
- M-A Richard
- Department of Dermatology, Aix-Marseille University, La Timone University Hospital, Marseille, France; CEReSS-EA 3279, Health Services and Quality of Life Research Centre, Aix Marseille University, Dermatology Department, La Timone University Hospital APHM, 13385 Marseille, France
| | - M Saint Aroman
- Head of Corporate Medical Direction Pharma, Dermocosmetics Care & Personal Care, Pierre Fabre, France
| | - C Baissac
- Head of Patient Centricity, Dermocosmetics Care & Personal Care, Pierre Fabre, France
| | - S Merhand
- Association Française de l'Eczéma, Redon, France
| | | | - A Audouze
- Association Ichtyose France, Bellerive-Sur-Allier, France
| | - C Legrand
- France Acné Adolescents Adultes, Vincennes, France
| | - C Beausillon
- France Acné Adolescents Adultes, Vincennes, France
| | - M Carre
- Association Française du Vitiligo, Paris, France
| | - H Raynal
- Solidarité Verneuil, Villeurbanne, France
| | - C Bergqvist
- Department of Dermatology, CHU Henri Mondor, Créteil, France
| | - C Taieb
- European Market Maintenance Assessment, Patients Priority Dpt, Fontenay sous Bois, France.
| | - B Cribier
- Clinique Dermatologique, University Hospital, Strasbourg, France
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The impact of complete clearance and almost complete clearance of psoriasis on quality of life: a literature review. Arch Dermatol Res 2022; 315:699-706. [PMID: 36336722 DOI: 10.1007/s00403-022-02420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/15/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin condition with systemic manifestations that have a detrimental impact on a patient's quality of life, affecting social, psychological, and sexual aspects of life. Complete clearance of lesions is a meaningful end goal of treatment; however, it is often difficult for patients to achieve. In this literature review, we summarized past studies that compared patients who achieved complete clearance to those who were almost clear to highlight the effect of complete clearance on psychological distress, social stigma, self-esteem, and interpersonal relationships in adult patients with psoriasis. METHODS A literature search was performed through the PubMed database using the keywords "clearance of psoriasis", "complete clearance of psoriasis", "psychological impact psoriasis", "social impact psoriasis", and "stigma of psoriasis". Age (< 18) and language (only articles written in English were included) were the only exclusion criteria to include adult patients only. The information was then collected and evaluated to compare complete clearance and almost complete clearance of psoriasis. RESULTS Of the patients with complete skin clearance (sPGA of 0), 61.4-91.1% reported a Dermatology Life Quality Index (DLQI) of 0, indicating no detectable impact of psoriasis on quality of life, compared to 45.7-48.3% who were almost clear. Patients who were completely clear felt psoriasis had less of an effect on their leisure activities and daily living compared to patients who were almost clear. Patient perceptions of disease severity also differed between the two groups, with the majority (65.5%) of those achieving complete clearance reporting a Psoriasis Symptom Inventory (PSI) of 0, which is consistent with their disease being "not at all severe", compared to 32.6% of those who were almost but not completely clear. While patients with complete clearance achieve a DLQI of 0 at a higher rate than those who have only almost complete clearance, the difference in the mean DLQI between patients with sPGA of 0 (completely clear) and sPGA of 1 (almost clear) is less than the minimal clinically important difference (MCID of 3-5) of the DLQI.
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10
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Samela T, Cordella G, Antinone V, Sarandrea P, Giampetruzzi AR, Abeni D. The use of SCL-k-9 to measure general psychopathology in women and men with skin conditions. Front Psychol 2022; 13:977264. [PMID: 36337481 PMCID: PMC9632958 DOI: 10.3389/fpsyg.2022.977264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To measure general psychopathology in dermatologic outpatients using the Symptom-Checklist-K-9 (SCL-K-9); to investigate whether the SCL-K-9 is able to categorize patients with and without significant non-psychotic disorders; and to perform a single-item analysis of the SCL-K-9, with a focus on gender differences. Methods Cross-sectional study on consecutive dermatological patients. We used two self-administered questionnaires to assess general psychopathology symptoms: General Health Questionnaire-12 (GHQ-12) and SCL-K-9. Sociodemographic information was collected with standardized forms. The performance of the SCL-K-9 in classifying patients according to their current emotional distress severity was assessed using a ROC procedure. Finally, we measured differences in scores obtained among women and men in SCL-K-9 single items. Results A total of 292 patients were studied (71.2% women). We observed statistically significant differences in SCL-K-9 total mean scores and in most single items among genders. We found that it would be more appropriate to use gender-specific cut-offs when using SCL-K-9 to screen dermatological patients for general psychopathology. Conclusion The SCL-K-9, with its compact format could provide, in a short time, a wide range of information related to critical areas that challenge the mental health of patients with skin diseases.
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Affiliation(s)
- Tonia Samela
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
- Clinical Psychology Unit, IDI-IRCCS, Rome, Italy
- *Correspondence: Tonia Samela,
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11
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The impact of gender and sex in psoriasis: What to be aware of when treating women with psoriasis. Int J Womens Dermatol 2022; 8:e010. [PMID: 35619672 PMCID: PMC9112394 DOI: 10.1097/jw9.0000000000000010] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/02/2022] [Indexed: 12/25/2022] Open
Abstract
Psoriasis is a common chronic inflammatory skin disease with an exceptionally high burden for women.
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12
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Wei L, Chen S, Zhang Z, Kuai L, Zhang R, Yu N, Shi Y, Li B, Wang R. Prevalence of Tobacco Smoking and Its Association With Disease Severity Among Patients With Psoriasis in China: A Cross-Sectional Study. Front Med (Lausanne) 2022; 9:883458. [PMID: 35646971 PMCID: PMC9133951 DOI: 10.3389/fmed.2022.883458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Tobacco smoking is associated with the onset and severity of psoriasis, and understanding the prevalence of tobacco smoking among patients with psoriasis is critical due to its high physical and mental influence and heavy disease burden. However, evidence on the association between tobacco smoking and psoriasis severity is still limited in China. Objectives The objective of this study was to examine the prevalence of tobacco smoking and explore the association between tobacco smoking and diseases severity among patients with psoriasis. Methods A total of 4,529 patients with psoriasis in 200 selected hospitals were recruited in China between January 2020 and September 2021. Detailed information covering demographic feature, tobacco smoking, and psoriasis history were collected through an electronic questionnaire, and clinical data were extracted from the health information system (HIS). SAS 9.4 was used for data analysis, and a p-value of <0.05 was considered statistically significant. Results The prevalence of tobacco smoking was 30.8%, with 24.6% for current smoking. The average Psoriasis Area and Severity Index (PASI) score for patients with psoriasis was 9.4, with male patients having a higher PASI score than female patients. The odds ratio (OR) of former tobacco smoking prevalence was 1.5 [95% confidence interval (CI): (1.0-2.3)] for PASI score (3.0-7.0), 2.2 for PASI score (7.1-13.0), and 4.2 for PASI score >13, when compared with patients with PASI score < 3.0. Similarly, the OR of current tobacco smoking prevalence was 1.8 [95% CI: (1.5-2.2)] for PASI score (3.0-7.0), 1.9 for PASI score (7.1-13.0), and 3.1 for PASI score >13, when compared with patients with PASI score <3.0. The Spearman correlation analysis indicated that both tobacco smoking intensity and smoking duration were positively correlated with psoriasis severity (p < 0.05). Conclusion The prevalence of tobacco smoking was high, especially among male patients with psoriasis and those with senior high education. Tobacco smoking was positively associated with psoriasis severity; moreover, both smoking intensity and smoking duration were positively correlated with the severity of psoriasis in a dose-dependent fashion.
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Affiliation(s)
- Lei Wei
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- National Clinical Research Center for Skin and Immunity Diseases, Beijing, China
| | - Siting Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhan Zhang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui Zhang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Ning Yu
- Department of Dermatology, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Bin Li
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruiping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
- National Clinical Research Center for Skin and Immunity Diseases, Beijing, China
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13
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McBride SR, Fargnoli MC, Fougerousse AC, García Bustínduy M, Catton L, Senturk L, Ecoffet C, Koren J, Andreoli L, Coates LC, Titialii A. Impact of psoriatic disease on women aged 18 to 45: Results from a multinational survey across 11 European countries. Int J Womens Dermatol 2022; 7:697-707. [PMID: 35028368 PMCID: PMC8714576 DOI: 10.1016/j.ijwd.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Plaque psoriasis (PSO) is a long-term inflammatory condition that can cause concomitant joint symptoms (psoriatic arthritis [PsA]) in up to 30% of patients. The impact of psoriatic disease on disease outcomes and quality of life is greater in women than men. Objective We evaluated the impact of psoriatic disease on women aged 18 to 45 years across Europe. Methods Women aged 18 to 45 years with moderate to severe PSO, PsA, or PSO + PsA (PSO with progression to PsA) and prior biologic experience were recruited from market research panels and patient association groups of the International Federation of Psoriasis Associations, European Federation of Psoriasis Patient Associations, and Arthritis Ireland and asked to complete a survey. Questions covered social and psychological wellbeing, employment, and family planning. Question types included 5- or 7-point agreement scales, where the highest/lowest two ratings were considered agreement/disagreement, respectively. The results are reported as proportions of those who selected the answer, divided by overall respondents for each question. Women were not required to answer all questions. Results Survey respondents (N = 573) had a diagnosis of PSO (n = 236), PsA (n = 173), or PSO + PsA (n = 164). Women self-reported similar mean scores for physical (57.0 of 100) and mental (59.0 of 100) health. A fifth (21%) had not achieved their desired career due to PSO/PsA; career dissatisfaction and increased sick leave were linked to poor mental health. Some women reported having a limited social life (33%), smaller families (34%), and being more likely to adopt children (27%) due to PSO/PsA. A quarter of women (27%) reported not understanding enough about PSO/PsA (nonmembers vs. members of patient association groups: 37% vs. 8%). Conclusion Our findings highlight the considerable burden of psoriatic disease on women of childbearing age. Increased provision of information tailored to women, training for health care professionals, and shared decision-making between patients and health care professionals may help better support women with psoriatic disease.
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Affiliation(s)
- Sandy R McBride
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Maria C Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anne-Claire Fougerousse
- Department of Dermatology, GEM ResoPso, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Marta García Bustínduy
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, San Cristobal de La Laguna, Spain
| | | | | | | | | | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Alice Titialii
- International Federation of Psoriasis Associations, Stockholm, Sweden
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14
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Sahin E, Hawro M, Weller K, Sabat R, Philipp S, Kokolakis G, Christou D, Metz M, Maurer M, Hawro T. Prevalence and factors associated with sleep disturbance in adult patients with psoriasis. J Eur Acad Dermatol Venereol 2022; 36:688-697. [PMID: 35020226 DOI: 10.1111/jdv.17917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep, which is crucial for restoring of physiological functions and health, is reportedly impaired in psoriasis. The role of different potential sleep confounding factors, including detailed pruritus characteristics, and the complex interplay between psychological variables (anxiety and depression), pruritus and sleep disturbance in psoriasis remain insufficiently investigated. OBJECTIVES To investigate sleep characteristics and to identify clinical, demographic, and psychological factors associated with sleep disturbance in psoriasis. METHODS This cross-sectional study included 334 psoriasis patients (response rate 86%) and 126 control subjects (response rate 82%). Measures included sleep quality [Pittsburgh Sleep Quality Index (PSQI)], psoriasis severity, pruritus characteristics, including average pruritus intensity [Visual Analogue Scale (VAS)], severity of comorbidities, anxiety and depression (Hospital Anxiety and Depression Scale - HADS), and quality of life (Dermatology Life Quality Index - DLQI, and Short Form 12 - SF12). RESULTS Fifty-nine percent of patients, and 34% of control subjects (P<0.001) suffered from sleep disturbance (PSQI>5). Patients slept 1 hour less than control subjects (median 6 vs. 7 hours, P<0.001). Patients without pruritus had less impaired sleep (global PSQI) than patients with strong (P<0.001) and very strong pruritus (P<0.001). Anxiety (HADS-A) and depression (HADS-D) levels were the strongest predictors of sleep impairment, followed by pruritus exacerbation at night, age, female sex, pruritus exacerbation in the morning, average pruritus intensity (VAS), diagnosed depression and gastroesophageal reflux disease, altogether explaining 32% - 37% of the variance in global sleep quality. Both, anxiety (HADS-A) and depression (HADS-D) were significant mediators explaining the association between pruritus intensity (VAS) and sleep impairment in 42% and 37%, respectively. CONCLUSIONS Sleep disturbance in patients with psoriasis is highly prevalent. Patients with psoriasis should be assessed for sleep impairment, pruritus, anxiety, and depression. Reduction of pruritus should be considered as an important therapeutic goal, along with therapies aimed at reducing anxiety and depression.
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Affiliation(s)
- E Sahin
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Hawro
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Weller
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Philipp
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - G Kokolakis
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - D Christou
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Metz
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Maurer
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Hawro
- Dermatological Allergology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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Zhang H, Yang Z, Tang K, Sun Q, Jin H. Stigmatization in Patients With Psoriasis: A Mini Review. Front Immunol 2021; 12:715839. [PMID: 34867945 PMCID: PMC8634029 DOI: 10.3389/fimmu.2021.715839] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Psoriasis is a chronic and recurrent immune-related skin disease that often causes disfigurement and disability. Due to the visibility of lesions in patients and inadequate understanding of dermatology knowledge in the general public, patients with psoriasis often suffer from stigma in their daily lives, which has adverse effects on their mental health, quality of life, and therapeutic responses. This review summarized the frequently used questionnaires and scales to evaluate stigmatization in patients with psoriasis, and recent advances on this topic. Feelings of Stigmatization Questionnaire, Questionnaire on Experience with Skin Complaints, and 6-item Stigmatization Scale have been commonly used. The relationship between sociodemographic characteristics, disease-related variables, psychiatric disorders, quality of life, and stigmatization in patients with psoriasis has been thoroughly investigated with these questionnaires. Managing the stigmatization in patients with psoriasis needs cooperation among policymakers, dermatologists, psychologists, psychiatrists, researchers, and patients. Further studies can concentrate more on these existing topics, as well as other topics, including predictors of perceived stigmatization, stigmatization from non-patient groups, influence of biologics on stigmatization, and methods of coping with stigmatization.
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Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zihan Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keyun Tang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuning Sun
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Kowalewska B, Jankowiak B, Krajewska-Kułak E, Milewski R, Sobolewski M. Skin-Disease Specific and Generic Psychometric Measures in Patients with Psoriasis. Dermatol Ther (Heidelb) 2021; 11:1999-2015. [PMID: 34585342 PMCID: PMC8478271 DOI: 10.1007/s13555-021-00609-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Psychosocial problems of patients with chronic dermatoses, such as psoriasis, add to their somatic ailments, which results in the lack of illness acceptance, lowered self-esteem, deteriorated quality of life, and an array of somatic comorbidities. The aim of this study was to analyze the effect of psoriasis on the quality of life, sense of stigmatization, self-esteem, and satisfaction with life in patients with psoriasis. METHODS The study was based on a short survey prepared by the authors and five validated scales: Dermatology Life Quality Index (DLQI), 6-Item Stigmatization Scale, 33-Item Feelings of Stigmatization Questionnaire, Rosenberg Self-Esteem Scale (SES), and Satisfaction With Life Scale (SWLS). The study included 111 patients with psoriasis (46.8% women and 53.2% men). The inclusion criteria of the study were the diagnosis of plaque psoriasis and written informed consent to participate. RESULTS DLQI scores ranged between 0 and 28 points (pts) (mean 10.8 pts). Mean stigmatization scores determined with the 33- and 6-Item Stigmatization Scale were 81.6 pts and 7.5 pts, respectively. The mean SWLS score for the study group (18.5 pts) was slightly below the average. The mean score SES of 27 pts implies that the study respondents' self-esteem level was slightly above the average. CONCLUSIONS Satisfaction with life turned out to be significantly modulated by overall stigmatization level on the 33-Item Stigmatization Scale (the stronger the sense of stigmatization, the lower the satisfaction with life) and education (respondents with higher education presented with higher satisfaction with life than those with non-higher education).
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Affiliation(s)
- Beata Kowalewska
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland.
| | - Barbara Jankowiak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Elżbieta Krajewska-Kułak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Rafał Milewski
- Doctoral Studies at Faculty of Health Sciences, Department of Primary Healthcare, Medical University of Bialystok, Białystok, Poland
| | - Marek Sobolewski
- Faculty of Management, Rzeszow University of Technology, Rzeszów, Poland
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17
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Hölsken S, Krefting F, Schedlowski M, Sondermann W. Expectation-induced enhancement of pain, itch and quality of life in psoriasis patients: study protocol of a randomised controlled trial. BMJ Open 2021; 11:e047099. [PMID: 34475155 PMCID: PMC8413966 DOI: 10.1136/bmjopen-2020-047099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Experimental and clinical data demonstrate that skin diseases like psoriasis are affected by psychological factors and can be modulated by interventions other than conventional drug therapy. The expectation of patients towards the benefit of a forthcoming treatment as well as treatment pre-experiences have been demonstrated as crucial factors mediating placebo responses in inflammatory skin diseases. However, it is unknown whether and to what extent treatment outcomes of psoriasis patients under therapy with monoclonal antibodies like secukinumab can be experimentally modulated at subjective and physiological levels by modifying the expectation of patients via verbal instruction or prior experience. METHODS AND ANALYSIS Treatment expectations will be modulated in patients with moderate-to-severe psoriasis undergoing treatment with the anti-interleukin-17A monoclonal antibody secukinumab. Patients with a Psoriasis Area and Severity Index (PASI) >12 will be randomly allocated to one of three groups (N=40 each). As a standard schedule, patients in the pharmacological control group (group 1) will be treated weekly with 300 mg secukinumab, while patients in groups 2 and 3 will receive only 75 mg secukinumab (75% dose reduction) during all treatment weeks. In addition to the injections, patients in group 3 will ingest a novel tasting drink, with a cover story explaining that previous studies showed additional beneficial effects of this combination (drug and drink). Patients will be assessed and treated at nine visits over a 16-week period, during which the severity of pain and itch symptoms, skin lesions and quality of life will be analysed with standardised questionnaires and the PASI. ETHICS AND DISSEMINATION This study was approved by the Ethics committee of the Medical Faculty of the University Duisburg-Essen. Study outcomes will be published in peer-reviewed scientific journals.
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Affiliation(s)
- Stefanie Hölsken
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frederik Krefting
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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18
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Spindler M, Przybyłowicz K, Hawro M, Weller K, Reidel U, Metz M, Maurer M, Hawro T. Sleep disturbance in adult dermatologic patients: A cross-sectional study on prevalence, burden, and associated factors. J Am Acad Dermatol 2021; 85:910-922. [PMID: 33864837 DOI: 10.1016/j.jaad.2021.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sleep disturbance remains insufficiently characterized in many dermatoses. OBJECTIVE To investigate the prevalence, burden, and factors associated with sleep disturbance in dermatologic patients. METHODS We recruited 800 patients and recorded pruritus characteristics and sociodemographic and clinical parameters. Validated questionnaires were used to assess sleep disturbance, psychological distress, health-related quality of life, and work productivity. RESULTS Two thirds of patients met criteria of poor sleep, which was associated with psychological distress, diminished health-related quality of life, and lost work productivity. Patients with average and maximum pruritus on the visual analog scale exceeding 5 and 6.5 points, respectively, were at high risk of suffering pruritus-related sleep disturbance. Overall pruritus intensity and its nocturnal exacerbation contributed independently to sleep disturbance. Psychological distress was of even higher impact on sleep than pruritus and almost a third of the relationship between pruritus intensity and sleep was mediated by psychological distress. CONCLUSION Sleep disturbance is prevalent in dermatologic patients and constitutes a considerable burden. CLINICAL IMPLICATION Dermatologic patients with intense pruritus and psychological distress should be examined for sleep disorders. Adequate antipruritic therapy and complementary psychotherapy in affected patients may help them regain restorative sleep.
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Affiliation(s)
- Max Spindler
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katarzyna Przybyłowicz
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marlena Hawro
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karsten Weller
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reidel
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Metz
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomasz Hawro
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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19
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Peng C, Xu X, Chen W, Li X, Yi X, Ding Y, Yu N, Lu J. Epidemiological Variations in the Global Burden of Psoriasis, an Analysis With Trends From 1990 to 2017. Front Med (Lausanne) 2021; 8:585634. [PMID: 33604344 PMCID: PMC7884455 DOI: 10.3389/fmed.2021.585634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/06/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Although there have been many epidemiological studies, research focusing on psoriasis' health burden on a global scale is still lacking. Trends and variations in the global health burden of psoriasis are evaluated by time, age, gender, geographical location, and socioeconomic status, using disability-adjusted life years (DALYs) from the Global Burden of Disease Study. Methods: The health burden of psoriasis was evaluated by DALYs, which combined years lost to disability (a morbidity component) with years of life lost (a mortality component). The global and national DALYs number, crude DALYs rate, and age-standardized DALYs rate were obtained from the GBD 2017 study database. The corresponding human development index (HDI) was collected from the United Nations Development Programme. Results: From 1990 to 2017, the DALYs number and crude DALYs rate due to psoriasis increased by 73 and 22%, respectively. In comparison, the age-standardized DALYs rate showed a slight increase. Patients in the age range of 65–69 years bear a more significant psoriasis burden. Both males and females showed an increasing trend in burden caused by psoriasis over the past 27 years, with females bearing a more significant psoriasis burden than males. The health burden of psoriasis was substantially unequal in geography with a Gini coefficient of 0.27. The concentration indexes indicated a socioeconomic associated inequality in psoriasis burden with values of 0.22, accounting for 48.64% variance across countries (R2 = 0.4864, p < 0.001). Between-nation inequality in the distribution of psoriasis burden continued to decline throughout the past 27 years. Gini coefficients of psoriasis burden decreased from 0.280 in 1990 to 0.265 in 2017. The concentration indexes indicated the same trend with 0.236 in the 1990s and 0.223 in 2017. Conclusions: Global health progress in psoriasis together with inequality in the past few decades. Although the inequality of psoriasis burden has shown some improvement during the past 27 years, disparities still exist in age, gender, geographical location, as well as socioeconomic status. The findings of this study highlight the global importance of psoriasis and is important in policy planning for psoriasis services on a global scale.
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Affiliation(s)
- Chen Peng
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Xin Xu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Wenjuan Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Xingzi Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Xuemei Yi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Ning Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
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20
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Germain N, Augustin M, François C, Legau K, Bogoeva N, Desroches M, Toumi M, Sommer R. Stigma in visible skin diseases - a literature review and development of a conceptual model. J Eur Acad Dermatol Venereol 2021; 35:1493-1504. [PMID: 33428316 DOI: 10.1111/jdv.17110] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
The burden of visible skin diseases (VSDs) includes not only physical symptoms but also psychosocial consequences such as depression, anxiety, impaired quality of life and low self-esteem. Stigmatization was shown to play a major role in people with skin diseases. The aim of the study was to review the evidence for the components, drivers and impacts of (self-)stigma, and to organize the data into a series of conceptual models. A targeted literature search was conducted to identify studies on (self-)stigma in relation to VSD. Conceptual models of stigma in VSDs were developed from existing generic conceptual models for VSD and of generic conceptual models of stigma and were refined after discussion with a board of experts, patient advocacy groups, clinicians and researchers. A total of 580 references were identified, of which 56 references were analysed and summarized. Two conceptual models of stigma were identified: one with external stigma and self-stigma dimensions, the other for self-stigma in mental health. These models were adapted to allow a complete description of stigma in VSDs. For this, a distinction was made between 'discrimination' and 'impact'. Finally, five models were developed: macro-overview; stigma, impact and socio-demographics; stigma, impact and disease characteristics; stigma, impact and quality of life; and stigma, impact and coping. Gaps were identified in available quantitative evidence. To our knowledge, this is the first conceptual model of stigma in VSDs. The model will help to standardize evaluation of stigma and to enhance empirical evaluation of anti-stigma interventions in VSDs. Further research should be conducted to develop a more complete model in stigma due to significant gaps in existing evidence, particularly including the stigma in others (external stigma) and also to cover a broader range of VSDs as their impact on particular dimensions of stigma differs.
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Affiliation(s)
- N Germain
- HEOR, Creativ-Ceutical, Paris, France
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - K Legau
- LEO Pharma, Kopenhagen, Denmark
| | - N Bogoeva
- HEOR, Creativ-Ceutical, Sofia, Bulgaria
| | | | - M Toumi
- Public Health Department, Aix-Marseille University, Marseilles, France
| | - R Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Jankowiak B, Kowalewska B, Krajewska-Kułak E, Kowalczuk K, Khvorik DF. The Sense of Stigmatization in Patients with Plaque Psoriasis. Dermatology 2020; 237:611-617. [PMID: 32841936 DOI: 10.1159/000510654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psoriasis is a systemic inflammatory disease capable of creating stigmatization in the form of social exclusion and decrement of psychological conditions. AIM The aim of the study was to determine the level of stigmatization in patients with plaque psoriasis. METHODS The study included 166 patients with plaque psoriasis (55.6% women and 44.3% men) with Psoriasis Area and Severity Index scores ≤10. The age of the study patients ranged between 18 and 72 years (arithmetic mean = 37.4; median = 38; standard deviation [SD] = 11.0). The mean age at the diagnosis of psoriasis was 21.5 years (median = 20; SD = 9.1) and disease duration varied from 2 to 59 years (arithmetic mean = 15.8; median = 15; SD = 11.3). The study patients completed the Polish version of the 6-item Stigmatization Scale and the 33-item Feelings of Stigmatization Questionnaire and a survey developed by the authors of this study, containing questions about the participants' sociodemographic characteristics (sex, age, place of residence, marital status, education, employment status) and information about their disease (location of psoriatic lesions, time elapsed since the diagnosis of psoriasis). RESULTS The mean score for the 6-item Stigmatization Scale for the whole study group was 7.6 out of 18 points (median = 7; SD = 3.8; minimum = 0; maximum = 17). The average score for the 33-item Stigma Feelings Questionnaire in our series was 84.5 out of 165 points (median = 88; SD = 20.9; minimum = 30; maximum = 136). A statistically significant sex-related difference was observed in the 6-item Stigmatization Scale scores, with higher stigmatization levels found in men than in women (p = 0.0082). Moreover, significantly higher levels of stigmatization were observed in countryside dwellers (p = 0.0311) and unmarried persons (p = 0.0321). Patients with a longer history of the disease (≥15 years) scored significantly higher on the 6-item Stigmatization Scale (p = 0.0217) than those in whom psoriasis lasted less long, and presented with higher, at the threshold of statistical significance, scores for the 33-item Feelings of Stigmatization Questionnaire. CONCLUSIONS Stigmatization awareness should be promoted among physicians and psoriatic patients to improve psoriasis management.
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Affiliation(s)
- Barbara Jankowiak
- Department of Integrated Medical Care, Medical University of Białystok, Białystok, Poland,
| | - Beata Kowalewska
- Department of Integrated Medical Care, Medical University of Białystok, Białystok, Poland
| | | | - Krystyna Kowalczuk
- Department of Integrated Medical Care, Medical University of Białystok, Białystok, Poland
| | - Dzmitry F Khvorik
- Department of Dermatovenereology, Medical University of Grodno, Grodno, Belarus
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22
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The characteristics and impact of pruritus in adult dermatology patients: A prospective, cross-sectional study. J Am Acad Dermatol 2020; 84:691-700. [PMID: 32798581 DOI: 10.1016/j.jaad.2020.08.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pruritus often accompanies chronic skin diseases, exerting considerable burden on many areas of patient functioning; this burden and the features of pruritus remain insufficiently characterized. OBJECTIVE To investigate characteristics, including localization patterns, and burden of pruritus in patients with chronic dermatoses. METHODS We recruited 800 patients with active chronic skin diseases. We assessed pruritus intensity, localization, and further characteristics. We used validated questionnaires to assess quality of life, work productivity and activity impairment, anxiety, depression, and sleep quality. RESULTS Nine out of every 10 patients had experienced pruritus throughout their disease and 73% in the last 7 days. Pruritus often affected the entire body and was not restricted to skin lesions. Patients with moderate to severe pruritus reported significantly more impairment to their sleep quality and work productivity, and they were more depressed and anxious than control individuals and patients with mild or no pruritus. Suicidal ideations were highly prevalent in patients with chronic pruritus (18.5%) and atopic dermatitis (11.8%). CONCLUSIONS Pruritus prevalence and intensity are very high across all dermatoses studied; intensity is linked to impairment in many areas of daily functioning. Effective treatment strategies are urgently required to treat pruritus and the underlying skin disease.
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23
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Özer İ, Yıldırım Dİ. Social awareness about psoriasis: Misconceptions, negative prejudices and discriminatory behavior. Dermatol Ther 2020; 33:e14059. [PMID: 32705739 DOI: 10.1111/dth.14059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022]
Abstract
Psoriasis patients experience negative attitudes and behaviors exhibited by people who have insufficient knowledge about psoriasis. In this study, the knowledge level of the society about psoriasis; people's attitudes toward such patients were investigated. A questionnaire that investigates the knowledge, attitudes, and behaviors related to psoriasis according to age, gender, and education levels was applied to the participants. About a quarter of participants in the study did not have any knowledge about psoriasis, 22.9% participants who thought that they knew about psoriasis believed that psoriasis was an infectious disease, 34.2% indicated that they were afraid of shaking hands with patients who had psoriasis, 45.4% did not wish to eat any food prepared by such patients, and 13.4% did not want to work with them in the same workplace. Female participants were more concerned that psoriasis was contagious (P = .030) than male participants, and they were more concerned about shaking hands (P = .022) and eating food prepared by psoriasis patients (P = .009). Both the psoriasis is little known and the level of knowledge of the participants who think they have knowledge about psoriasis was insufficient and prejudiced attitudes and behaviors are common in patients with psoriasis.
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Affiliation(s)
- İlkay Özer
- Meram Faculty of Medicine, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Duygu İlke Yıldırım
- Department of Family Medicine, Konya Health Application and Research Center, University of Health Sciences, Konya, Turkey
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24
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Wan MT, Pearl RL, Chiesa Fuxench ZC, Takeshita J, Gelfand JM. Anticipated and Perceived Stigma Among Patients With Psoriasis. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2020; 5:93-99. [PMID: 33733037 PMCID: PMC7963348 DOI: 10.1177/2475530320924009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Perceived stigma among patients with psoriasis (PWP) is associated with poorer quality of life. OBJECTIVE To determine the prevalence and predictors of stigmatizing attitudes that PWP expect and experience from others. METHODS We conducted a survey using validated outcome measures to assess the extent to which PWP anticipate and perceive stigma from others. Demographic and clinical characteristics were obtained from electronic medical records. RESULTS Patients (n = 106) were 48.11% female, 70.75% white, and had a mean age ± SD of 47.90 ± 16.19 years old. Of all, 25.47% self-reported their psoriasis as severe. Mean physician global assessment score ± SD was 2.98 ± 1.81. Two-thirds (66.98%) of patients reported that, in response to seeing their psoriasis-affected skin, they anticipated others to stereotype them as "contagious." Linear regression analyses demonstrated that patient-reported severe psoriasis, compared to mild psoriasis, was associated with greater anticipation of negative stereotypes, social avoidance, and perceived stigma from others (P values < .05). Physician-measured body surface area and global assessment scores were not significantly associated with any outcome. CONCLUSION Prevalence of anticipated and perceived stigma among PWP is high. Our results suggest that objective measures of severity may not identify patients at risk of stigma-related distress. Additional methods, such as directly inquiring about stigmatizing experiences, may be needed.
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Affiliation(s)
- Marilyn T Wan
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rebecca L Pearl
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zelma C Chiesa Fuxench
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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25
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Kowalewska B, Cybulski M, Jankowiak B, Krajewska-Kułak E. Acceptance of Illness, Satisfaction with Life, Sense of Stigmatization, and Quality of Life among People with Psoriasis: A Cross-Sectional Study. Dermatol Ther (Heidelb) 2020; 10:413-430. [PMID: 32193842 PMCID: PMC7211781 DOI: 10.1007/s13555-020-00368-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Psoriasis is a complex disease with a heterogeneous presentation, which may have a profound effect on the everyday functioning of patients. As a strongly stressogenic disease, psoriasis may cause lack of illness acceptance and contribute to negative changes in self-image. Usually, psoriasis also has a detrimental effect on quality of life. The aim of this study is to determine the levels of illness acceptance, satisfaction with life, stigmatization, and quality of life in people with psoriasis, to analyze relationships among these variables, and to verify whether they are modulated by selected sociodemographic factors. METHODS A total of 366 people with psoriasis treated at the Dermatology and Medical Cosmetology Clinic in Białystok were included. The study was conducted using a short survey prepared by the authors and five validated psychometric scales: Acceptance of Illness Scale (AIS), Satisfaction with Life Scale (SWLS), 6-item Stigmatization Scale, 33-item Feelings of Stigmatization Questionnaire, and Dermatology Life Quality Index (DLQI). RESULTS Median AIS score was 24 pts, which corresponds to a moderate level of illness acceptance. The level of illness acceptance among men was significantly higher than among women. More than half of respondents assessed their satisfaction with life as low. Men showed low levels of satisfaction with life slightly more often than women. Patients living in the countryside showed high levels of satisfaction with life significantly more often than those living in cities/towns. Mean scores for the 6-item Stigmatization Scale and the 33-item Feelings of Stigmatization Questionnaire were 8.73 pts and 90.06 pts, respectively, with no significant differences between the results of male and female patients. The DLQI scores for the study group ranged between 0 and 30 pts, with the mean value of 17.81 pts corresponding to a severe deterioration of quality of life. Statistically significant differences between quality of life and all sociodemographic variables were demonstrated. CONCLUSIONS People with psoriasis participating in this study showed moderate levels of illness acceptance and stigmatization, low level of satisfaction with life, and moderately deteriorated quality of life. Acceptance of illness was significantly modulated by patient sex. The level of illness acceptance among men was significantly higher than among women. Furthermore, illness acceptance exerted a significant effect on satisfaction with life in psoriasis patients. Place of residence exerted significant effects on satisfaction with life (higher in countryside dwellers), sense of stigmatization (stronger in countryside dwellers), and quality of life (more severely deteriorated in city/town dwellers). Disease duration significantly affected the degree of life satisfaction, sense of stigmatization (measured using a 33-item Feelings of Stigmatization Questionnaire), and quality of life among patients with psoriasis.
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Affiliation(s)
- Beata Kowalewska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, M. Skłodowskiej-Curie 7A str., 15-096, Białystok, Poland
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, M. Skłodowskiej-Curie 7A str., 15-096, Białystok, Poland.
| | - Barbara Jankowiak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, M. Skłodowskiej-Curie 7A str., 15-096, Białystok, Poland
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, M. Skłodowskiej-Curie 7A str., 15-096, Białystok, Poland
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26
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Napolitano M, Mastroeni S, Fania L, Pallotta S, Fusari R, Uras C, Panebianco A, Cavani A, Sampogna F, Abeni D. Sex- and gender-associated clinical and psychosocial characteristics of patients with psoriasis. Clin Exp Dermatol 2020; 45:705-711. [PMID: 32170752 DOI: 10.1111/ced.14218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sex and gender may affect disease prevalence, adverse effects and response to therapy. AIM To analyse sex and gender differences in outpatients with psoriasis. METHODS A cross-sectional study was conducted at IDI-IRCCS, Rome, over a 3-year period. In total, 3023 patients with psoriasis were enrolled. Anthropometric and demographic characteristics were recorded, and a dermatologist evaluated the clinical severity of disease. Quality of life (QoL) questionnaires were collected. Univariate and multivariate analyses were performed to examine factors associated with sex. RESULTS We found sex- and gender-associated differences in clinical characteristics, disease severity, psychological distress and quality of life. Male sex was associated with body mass index, smoking, alcohol consumption, Psoriasis Area Severity Index ≥ 10 and age at onset ≥ 20 years. Female sex was associated with family history of diabetes, joint involvement, clinical type other than diffuse plaque psoriasis, higher psychological distress and a greater effect on QoL. CONCLUSION Our study identified sex and gender differences of potential clinical relevance in psoriasis.
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Affiliation(s)
- M Napolitano
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - S Mastroeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - L Fania
- I Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - S Pallotta
- V Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - R Fusari
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - C Uras
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | | | | | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
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Alpsoy E, Polat M, Yavuz IH, Kartal P, Didar Balci D, Karadag AS, Bilgic A, Arca E, Karaman BF, Emre S, Adisen E, Sendur N, Bilgic O, Cordan Yazici A, Yalcin B, Koca R, Gunduz K, Borlu M, Ergun T, Dursun P, Bilgili SG, Surer Adanir A, Gulekon A, Yagcioglu G, Yilmaz E, Kavuzlu U, Senol Y. Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study. Ann Dermatol 2020; 32:181-188. [PMID: 33911736 PMCID: PMC7992623 DOI: 10.5021/ad.2020.32.3.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/30/2019] [Accepted: 12/13/2019] [Indexed: 11/08/2022] Open
Abstract
Background Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients. Objective We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. Methods This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. Results The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. Conclusion Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.
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Affiliation(s)
- Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mualla Polat
- Department of Dermatology and Venereology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Ibrahim Halil Yavuz
- Department of Dermatology and Venereology, Van Yuzuncu Yil University School of Medicine, Van, Turkey
| | - Pelin Kartal
- Department of Dermatology and Venereology, University of Health Sciences Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Didem Didar Balci
- Department of Dermatology and Venereology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ayse Serap Karadag
- Department of Dermatology and Venereology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Asli Bilgic
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ercan Arca
- Department of Dermatology and Venereology, Guven Hospital, Ankara, Turkey
| | | | - Selma Emre
- Department of Dermatology and Venereology, Yildirim Beyazit University Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Esra Adisen
- Department of Dermatology and Venereology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Neslihan Sendur
- Department of Dermatology and Venereology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ozlem Bilgic
- Department of Dermatology and Venereology, Selcuk University School of Medicine, Konya, Turkey
| | - Ayca Cordan Yazici
- Department of Dermatology and Venereology, Mersin University School of Medicine, Mersin, Turkey
| | - Basak Yalcin
- Department of Dermatology and Venereology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Rafet Koca
- Department of Dermatology and Venereology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Kamer Gunduz
- Department of Dermatology and Venereology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Murat Borlu
- Department of Dermatology and Venereology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Tulin Ergun
- Department of Dermatology and Venereology, Marmara University School of Medicine, Istanbul, Turkey
| | - Pinar Dursun
- Department of Dermatology and Venereology, Mersin State Hospital, Mersin, Turkey
| | - Serap Gunes Bilgili
- Department of Dermatology and Venereology, Van Yuzuncu Yil University School of Medicine, Van, Turkey
| | - Asli Surer Adanir
- Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ayla Gulekon
- Department of Dermatology and Venereology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gizem Yagcioglu
- Department of Dermatology and Venereology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ertan Yilmaz
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ufuk Kavuzlu
- Department of Dermatology and Venereology, Mersin University School of Medicine, Mersin, Turkey
| | - Yesim Senol
- Department of Medical Education, Akdeniz University School of Medicine, Antalya, Turkey
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Kwan Z, Yong S, Tan L, Ch'ng C, Yahya F, Pok S, Ch'ng P, Ong W, Woei Siew K, Aminuddin I, Ong L, Shin Lee A, Iskandar Zulkarnain L, Mohd Hanafiah N, Mustafa Rawther D, Chong J, Saw L, Tan M. Personal experience and knowledge about psoriasis reduce misconceptions and discriminatory behavior toward people living with psoriasis in Malaysia. DERMATOL SIN 2020. [DOI: 10.4103/ds.ds_27_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Pruritus and sleep disturbances in patients with psoriasis. Arch Dermatol Res 2019; 312:103-111. [DOI: 10.1007/s00403-019-01998-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
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Abstract
PURPOSE OF REVIEW The effects of skin disease on stigmatization are important but understudied in the pediatric population. Given the highly visible nature of dermatologic conditions, stigmatization is a common problem that requires significant attention in patients with skin diseases. In this review, we examine the recent literature addressing stigmatization of patients suffering from common dermatologic diseases with the goal to increase clinician awareness of these issues and identify new avenues for future research. RECENT FINDINGS A number of studies have examined the impact of skin disease on psychosocial well being and quality of life. Although some skin diseases are often overlooked medically and considered to be primarily cosmetic issues, the long-term consequences of skin diseases on psychosocial health, especially in pediatric patients, can be profound. SUMMARY The precipitating factors for stigma vary widely depending on age, sex, and culture. In order to effectively reduce the impact of pediatric skin diseases on psychosocial health, physicians should be able to identify specific characteristics that may increase risks for stigmatization in chidlren. Carefully monitoring psychosocial development in pediatric patients with dermatological conditions in addition to proactively guiding patients and families to appropriate resources can benefit the child's development and overall long-term well being.
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Affiliation(s)
- Julie H Wu
- Baylor College of Medicine, Houston, Texas
| | - Bernard A Cohen
- Department of Pediatrics.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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Gisondi P. Recognizing the differential impact of site of involvement on quality of life in dermatology. Br J Dermatol 2019; 181:229-230. [DOI: 10.1111/bjd.17788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P. Gisondi
- Department of Medicine Section of Dermatology and Venereology University of Verona Verona Italy
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32
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Gottlieb AB, Ryan C, Murase JE. Clinical considerations for the management of psoriasis in women. Int J Womens Dermatol 2019; 5:141-150. [PMID: 31360745 PMCID: PMC6637092 DOI: 10.1016/j.ijwd.2019.04.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 12/16/2022] Open
Abstract
The burden of psoriasis is particularly high for women, who report lower levels of happiness (women: 18.5%; men: 11.3% lower vs. general population) and are more likely to experience stress (women: > 60%; men: 42%), loneliness (women: 25-28%; men: 19-24%), stigmatization (Feelings of Stigmatization Questionnaire score; women: 93.2; men: 78.0), and reduced sexual activity (women: 33%; men: 19%) compared with men. The onset of psoriasis is bimodal, with one incidence peak (15-30 years) that coincides with the prime reproductive age for women, which poses specific challenges for their treatment. However, well-established guidelines for the treatment of women of childbearing age are lacking. Many women experience stabilization (21%) or improvement (55%) of their skin during pregnancy, but up to a quarter can experience disease worsening, and postpartum flares are common (> 50%). Therefore, balancing the risk of treatment with the risk of uncontrolled disease is important. Because half of pregnancies are unplanned, the implications of therapeutic options must be considered for all women with psoriasis who are sexually active, irrespective of intentions to start a family. Timely initiation of these discussions by health care professionals is paramount to prevent unintentional toxicity to the developing fetus. For example, acitretin, methotrexate, and oral psoralen/ultraviolet A are all contraindicated in pregnancy. Reassuringly, safety data for other psoriasis treatments during pregnancy are increasingly available, particularly for anti-tumor necrosis factor therapies. Despite encouraging data from pregnancy exposure registries and clinical studies now being included in anti-tumor necrosis factor drug labels, comfort with prescribing these therapies to pregnant women remains low (U.S. dermatologists: 21%; EU-5 dermatologists: 10%). In this article, we review issues specific to treating women of childbearing age with psoriasis and highlight the need for treatment guidelines to ensure consistent care and optimal outcomes for these patients.
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Affiliation(s)
- Alice B. Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
- Corresponding Author.
| | - Caitriona Ryan
- Blackrock Clinic and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Jenny E. Murase
- University of California San Francisco, San Francisco, and Palo Alto Medical Foundation, Mountain View, California
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33
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Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, Armstrong AW, Connor C, Cordoro KM, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kivelevitch D, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Lim HW, Paller AS, Parra SL, Pathy AL, Prater EF, Rupani R, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80:1073-1113. [PMID: 30772097 DOI: 10.1016/j.jaad.2018.11.058] [Citation(s) in RCA: 242] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
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Affiliation(s)
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California
| | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Augustin M, Sommer R, Kirsten N, Danckworth A, Radtke M, Reich K, Thaci D, Boehncke W, Langenbruch A, Mrowietz U. Topology of psoriasis in routine care: results from high‐resolution analysis of 2009 patients. Br J Dermatol 2019; 181:358-365. [DOI: 10.1111/bjd.17403] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 01/08/2023]
Affiliation(s)
- M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - R. Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - A. Danckworth
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - K. Reich
- Dermatologikum Berlin and SCIderm Research Institute Hamburg Germany
| | - D. Thaci
- Comprehensive Center for Inflammation Medicine University Hospital Schleswig‐Holstein Campus Lübeck Lübeck Germany
| | - W.H. Boehncke
- Department of Dermatology and Venereology Geneva University Hospitals Geneva Switzerland
| | - A. Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - U. Mrowietz
- Department of Dermatology University Medical Center Schleswig‐Holstein Campus Kiel Kiel Germany
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Abstract
The excellent response of psoriasis to anti-TNF-α(TNF)/IL23/IL17A biologics implies a crucial role for the TNF/IL23/IL17 axis in developing psoriasis. In addition to the TNF/IL23/IL17 axis provided by immune cells, current evidence points to an important contribution of TNF, IL23 and IL17C produced from non-hematopoietic keratinocytes. Therefore, crosstalk between immune cells and keratinocytes forms a multilayered feed-forward loop to accelerate the TNF/IL23/IL17A axis. Many biologics have already been licensed or are under clinical trials. Given that the IL-17 signature is more upregulated in the skin than in synovium in psoriatic arthritis, anti-IL-23/IL-17 agents seem to be superior to anti-TNF-α remedies in the treatment of skin lesions. In this review, we summarize recent topics in psoriasis and the TNF/IL23/IL17 axis.
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Affiliation(s)
- Kazuhisa Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Gaku Tsuji
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan -
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Pearl RL, Wan MT, Takeshita J, Gelfand JM. Stigmatizing attitudes toward persons with psoriasis among laypersons and medical students. J Am Acad Dermatol 2018; 80:1556-1563. [PMID: 30171876 DOI: 10.1016/j.jaad.2018.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perceived stigma among patients with psoriasis contributes to poor quality of life. OBJECTIVE To determine the prevalence and predictors of stigmatizing attitudes toward persons with psoriasis among laypersons and medical trainees. METHODS Laypersons were recruited from Amazon.com's Mechanical Turk (MTurk) (n = 198). Additionally, 187 medical students were recruited via e-mail. Participants completed an online survey in which they viewed images of persons with visible psoriasis. Participants reported their desire to socially avoid the persons in the images, their emotional responses to the persons in the images, and their endorsement of psoriasis-related stereotypes and myths. RESULTS MTurk participants endorsed social avoidance items such as not wanting to shake hands with (39.4%) or have the persons in the images in their home (32.3%). Participants stereotyped persons with psoriasis as contagious (27.3%) and endorsed the myth that psoriasis is not a serious disease (26.8%). Linear regression analyses showed that having heard of or knowing someone with psoriasis predicted fewer stigmatizing attitudes (P < .05). The medical students reported less stigmatizing attitudes than the MTurk participants (P < .01). LIMITATIONS Self-report, single-institution study. CONCLUSION Stigmatizing views of persons with psoriasis are prevalent among people in the United States. Educational campaigns for the public and medical trainees may reduce stigma toward persons with psoriasis.
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Affiliation(s)
- Rebecca L Pearl
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Marilyn T Wan
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Differential efficacy of biologic treatments targeting the TNF-α/IL-23/IL-17 axis in psoriasis and psoriatic arthritis. Cytokine 2018; 111:182-188. [PMID: 30172115 DOI: 10.1016/j.cyto.2018.08.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis and psoriatic arthritis cause significant physical and psychological burdens for afflicted individuals. An accelerated TNF-α/IL-23/IL-17 axis is their major pathomechanism; therefore, anti-TNF-α/IL-23/IL-17 biologics are very effective for the treatment of skin and joint lesions in psoriasis and psoriatic arthritis. Given that the IL-17 signature is more upregulated in the skin than in synovium in psoriatic arthritis, anti-IL-23/IL-17 agents seem to be superior to anti-TNF-α remedies in the treatment of skin lesions. In this review, we focus on the differential efficacy of anti-TNF-α/IL-23/IL-17 biologics in psoriasis and psoriatic arthritis.
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38
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Yang EJ, Beck KM, Sanchez IM, Koo J, Liao W. The impact of genital psoriasis on quality of life: a systematic review. PSORIASIS-TARGETS AND THERAPY 2018; 8:41-47. [PMID: 30214891 PMCID: PMC6118254 DOI: 10.2147/ptt.s169389] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psoriasis is a chronic immune-mediated inflammatory disease with significant medical and psychological comorbidities. In addition to having increased cardiovascular risk and mortality, psoriasis patients are more likely to be depressed, anxious, and endorse suicidal ideation than the general population. These patients often have low self-esteem and feel stigmatized due to their skin disease, which can prevent them from pursuing relationships, dating, and attending social activities. Up to 63% of adult psoriasis patients experience psoriatic lesions on their genital area during their lifetime, but often do not discuss these issues with their physicians due to embarrassment, stigmatization, or shyness about this sensitive location. However, psoriasis in sensitive areas, such as the genitals, may result in quality of life impairment greater than that of patients with psoriasis elsewhere on their body, particularly in respect to romantic relationships, intimacy, and sexual function. This article evaluates the current literature regarding the impact of genital psoriasis on the quality of life of affected patients.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA, .,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA,
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA,
| | - Isabelle M Sanchez
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA, .,University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - John Koo
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA,
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA,
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Affiliation(s)
- P. Gisondi
- Section of Dermatology and Venereology; Department of Medicine; University of Verona; Piazzale A. Stefani 1 37126 Verona Italy
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40
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Hawro T, Ohanyan T, Schoepke N, Metz M, Peveling-Oberhag A, Staubach P, Maurer M, Weller K. The Urticaria Activity Score—Validity, Reliability, and Responsiveness. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1185-1190.e1. [DOI: 10.1016/j.jaip.2017.10.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022]
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Furue K, Ito T, Tsuji G, Kadono T, Nakahara T, Furue M. Autoimmunity and autoimmune co-morbidities in psoriasis. Immunology 2018; 154:21-27. [PMID: 29315555 PMCID: PMC5904708 DOI: 10.1111/imm.12891] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/18/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is characterized by widespread scaly erythematous plaques that cause significant physical and psychological burdens for the affected individuals. Accelerated inflammation driven by the tumour necrosis factor-α/interleukin-23/interleukin-17 axis is now known to be the major mechanism in the development of psoriasis. In addition, psoriasis has an autoimmune nature that manifests as autoreactive T cells and is co-morbid with other autoimmune diseases, such as autoimmune bullous diseases, vitiligo, alopecia and thyroiditis. In this article, we review the recent topics on autoimmunity and autoimmune co-morbidities in psoriasis.
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Affiliation(s)
| | - Takamichi Ito
- Department of DermatologyKyushu UniversityFukuokaJapan
| | - Gaku Tsuji
- Department of DermatologyKyushu UniversityFukuokaJapan
| | - Takafumi Kadono
- Department of DermatologySt Marianna University School of MedicineKawasakiJapan
| | - Takeshi Nakahara
- Department of DermatologyKyushu UniversityFukuokaJapan
- Division of Skin Surface SensingDepartment of DermatologyKyushu UniversityFukuokaJapan
| | - Masutaka Furue
- Department of DermatologyKyushu UniversityFukuokaJapan
- Division of Skin Surface SensingDepartment of DermatologyKyushu UniversityFukuokaJapan
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42
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Kwan Z, Bong YB, Tan LL, Lim SX, Yong ASW, Ch'ng CC, Tan MP, Ismail R. Determinants of quality of life and psychological status in adults with psoriasis. Arch Dermatol Res 2018; 310:443-451. [PMID: 29687328 DOI: 10.1007/s00403-018-1832-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/24/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
We investigated whether disease severity and clinical manifestations were associated with depression, anxiety, stress and quality of life in adults with psoriasis. Participants were recruited from a dermatology outpatient clinic at a teaching hospital. Information on sociodemographic characteristics, disease severity, presence of arthropathy and head involvement was specifically recorded. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Quality of life and psychological symptoms were measured using the Dermatology Life Quality Index (DLQI) and the Depression Anxiety Stress Scale (DASS), respectively. One hundred individuals were recruited. Unadjusted analysis revealed that head involvement was associated with depression [odds ratio (OR) 8.509; 95% confidence interval (CI) 1.077-67.231] and anxiety (OR 6.46; 95% CI 1.401-29.858). Severe disease was associated with a poorer quality of life compared to mild disease (OR 3.750; 95% CI 1.330-10.577). Younger age was associated with an increased risk of depression [mean difference (MD) - 8.640; 95% CI - 16.390 to - 0.890], anxiety (MD - 11.553; 95% CI - 18.478 to- 4.628), stress (MD - 11.440; 95% CI - 19.252 to - 3.628) and severely impaired quality of life (MD - 12.338; 95% CI - 19.548 to - 5.127). Following adjustments for age and disease severity, anxiety, stress and depression remained associated with severely impaired quality of life.
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Affiliation(s)
- Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
| | - Yii Bonn Bong
- Institute of Research Management and Services, University of Malaya, Kuala Lumpur, Malaysia
| | - Leng Leng Tan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Shu Xian Lim
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Adrian Sze Wai Yong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chin Chwen Ch'ng
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rokiah Ismail
- School of Healthy Aging, Medical Aesthetics and Regenerative Medicine, UCSI University, Kuala Lumpur, Malaysia
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Piraccini BM, Starace M, Toft A. Early Visible Improvements during K101-03 Treatment: An Open-Label Multicenter Clinical Investigation in Patients with Onychomycosis and/or Nail Psoriasis. Dermatology 2017; 233:178-183. [PMID: 28787710 DOI: 10.1159/000478257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/02/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Onychomycosis and nail psoriasis can be embarrassing to patients, so improving the appearance of affected nails should be one of the key short-term goals of treatment. METHODS An 8-week open-label multicenter study was conducted to assess whether K101-03, a marketed topical treatment containing propylene glycol, glycerol, urea, and lactic acid, could produce rapid cosmetic improvements in affected nails. Adult patients with a big toenail or thumbnail (the "target" nail) affected by onychomycosis (n = 72) or psoriasis (n = 34) or both (n = 1) applied K101-03 to their affected nails once a day for 8 weeks. During and after treatment, patients rated the overall appearance of their target nail on a 4-point scale. They also assessed whether thickening, discoloration, brittleness, and softness of the target nail had improved since baseline. Adverse events (AEs) that occurred between the first application of K101-03 and the end of treatment were recorded and categorized according to severity and relationship to K101-03. RESULTS After 8 weeks of K101-03 treatment, 92.2% of patients (95% confidence interval [CI] 87.06-97.40) reported at least some improvement in the target nail. After 1 week of treatment, 78.3% of patients with onychomycosis (95% CI 68.53-87.99) reported at least some improvement in the target nail, and 55.1% of them reported that discoloration of their target nail had improved. Three patients reported a total of 5 AEs, none of which were judged to be related to K101-03. CONCLUSIONS In summary, K101-03 was well tolerated in patients with onychomycosis or nail psoriasis and rapidly improved their nails.
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Affiliation(s)
- Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine, Università di Bologna, Bologna, Italy
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