Sociodemographic, clinical and therapeutic factors as predictors of life quality impairment in psoriasis: A cross‐sectional study in Italy

Abstract

Psoriasis is a chronic inflammatory skin disease showing a high burden due to its aesthetic, social, psychological, and quality of life (QoL) implications which also affect patient‐physician relationship and, consequently, the adherence to treatments. Limited data on the natural history of psoriasis and factors predicting its prognosis are available. The aim of this study was to investigate patients' global characteristics, including treatments, associated with QoL impairment in psoriasis. Questionnaires evaluating sociodemographic features and Dermatology Life Quality Index (DLQI) were administered to patients. Multiple regression analysis was performed to evaluate factors associated with a large effect on patient's life (DLQI > 10), moderate effect on patient's life (DLQI ≥ 6 ≤ 10), small effect on patient's life (DLQI ≥ 2 < 6), and no effect on patient's life (DLQI < 2). Overall, 1052 consecutive patients affected by mild‐to‐severe psoriasis were recruited. Our logistic regression analysis showed that the influencing factors for a large effect on QoL were living in Southern Italy, depression, psoriatic arthritis, and psoriasis localization on facial, intertriginous, palmoplantar, trunk and scalp regions. For a moderate effect on patient's life, phototherapy and non‐biological systemic therapies resulted to be the predictive factors. Mild psoriasis, living in social housing and the isolated involvement of scalp psoriasis had a small effect on QoL. Lastly, mild psoriasis and current biological therapies including anti‐IL‐12/23, anti‐IL‐17, and anti‐TNF‐α were positively associated with no life quality impairment. Perceived quality of life impairment in psoriasis not only depends on the skin disease but rather on patients' global characteristics. Therefore, the individual background of these patients should be respected in the selection of treatment options.

The Impact of Psoriasis and Atopic Dermatitis on Quality of Life: A Literature Research on Biomarkers

“…There is evidence that dermatology-specific QoL but also SWL of PSO patients varies between countries, but also within different regions of a country [86][87][88][89]. Cultural differences, disparities in health care organization and access to treatment are subject of discussion for these regional differences [87] and should be considered in research and care.…”

“…Scientific evidence therefore indicates screening psoriatic patients for suicidal ideations and psychiatric disorders, with a focus on depression and anxiety, which are also well-known predictors of QoL impairment [106,115,120,121]. Joint and nail involvement, cutaneous comorbidities (e.g., vitiligo and AD) and metabolic syndrome symptoms have been shown to be associated with a reduction in QoL of patients as evidenced by DLQI, Skindex and PDI scores [88,[122][123][124][125]. In contrast, there is evidence that higher BMI is associated with a better mental-health related QoL in psoriatic patients [96,126].…”

“…Type of treatment has been shown to be a strong predictor of QoL among PSO and AD patients in clinical trials and real-life data. In detail, patients in receipt of biologic systemic therapy have been shown a better QoL compared to topical and conventional systemic treatment only [88,91,98,[127][128][129][130][131]. In Table 2, the sociodemographic, clinical and therapeutic factors associated with QoL impairment in PSO and AD are summarized.…”

“…Higher PASI score was associated with impaired QoL [92,98,108,115,116] Higher SCORAD showed more impaired QoL [100,103,105,113] Disease localization Isolated involvement of scalp, trunk, intertriginous, palmoplantar and nail PSO was associated with a higher QoL impairment [88,106,125] Isolated involvement of face, hand, genital and foot eczema was associated with low QoL [99,100]. Involvement of visible regions showed more impaired QoL than no involvement of visible regions in women [105] Comorbidities Patients with comorbidities such as hypertension, diabetes, lipid disorders, overweight/obesity, PSA, depression and anxiety had poorer QoL [98,106,124] Adults with AD concomitant other atopic diseases including asthma, allergic rhinitis, allergic conjunctivitis experienced greater QoL impairment than the patients with AD alone [103].…”

Psoriatic Foot Involvement is the Most Significant Contributor to the Inconsistency Between PASI and DLQI: A Retrospective Study from China

“…Our studies also supported that women, higher income, psoriatic arthritis, family history of psoriasis, and special sites (foot, scalp, face, neck, nails, hands) lead to a higher burden of disease is consistent with former studies. 22–24 However, if they had a PASI lower than 10, they could easily be considered mild rather than moderate to severe psoriasis. The DLQI outperforms the PASI in terms of indicating patient suffering and social costs.…”