Psoriasis Disability Index Scores Research Articles

Homoeopathy in Psoriasis Vulgaris with Special Emphasis on Modified Naranjo Criteria for Homeopathy: An Evidence-Based Case Report

Abstract Background Psoriasis is a chronic multisystem inflammatory disease with predominantly skin and joint involvement. Ample evidences suggest that psoriasis patients improve under homoeopathic treatment. The main objective of this documentation is to find out whether such improvement can be attributable to the homoeopathic treatment. Method A case of psoriasis vulgaris with the complaint of dry, scaly itching eruption on the extensor surface of both legs is presented here. Outcome-related to impact on daily living (ORIDL) was used to evaluate the patient-reported outcome related to his daily living, disease severity in the involved area was assessed by PASI (Psoriasis Area and Severity Index) scale and PDI (Psoriasis Disability Index) scale was used to assess the disease-specific quality of life. Photographs were taken as objective evidence after obtaining consent from the patient. The Modified Naranjo Criteria for Homeopathy (MONARCH) was used to find out the possible causal attribution of the treatment provided. Result The ORIDL score of (+4) showed the major improvement from patient and physician's perspective. PASI score reduced from ‘11.2 to 0’ (documented in photographs) within a plausible timeframe. The duration of remission of the skin lesion continued for six months. Each domain of PDI score reduced (from ‘25 to 3′) imparting improved quality of life. The high total score (+9 in ‘−6 to 13’ scale) of MONARCH suggested the likelihood of improvement was attributable to the homoeopathic intervention. This case has evidently shown its marked improvement with validated outcome measures.

Psycho-social determinants and magnitude of public health problems of psoriasis in Bangladesh

Background: Numerous studies have analyzed the influence of psoriasis on the quality of life and psychological health of patients. 0nly few studies have addressed the effect of the disease on individuals and cohabitants of psoriatic patients in developing countries, none in Bangladesh. Objective: To assess the clinical severity, the physical and psychosocial disability and to analyze their interrelationship in psoriasis patients and cohabitants. Methods: Hospital based cross-sectional study was conducted. The study included patients and cohabitants. The questionnaire was administered to the patient. Their quality of life was measured with the Psoriasis Disability index (PDI) and Family Dermatology Life Quality index (FDLQI), and their psychological state with Psoriasis life stress inventory (PLSI). The clinical severity by psoriasis area severity index (PASI) score. Appropriate test conducted using SPSS software. Result: 225 patients (138 males, 87 female) were included in the study. The clinical PASI scores correlated significantly with the over all physical disability PDI (<0.0001), stress incurred PLSI (<0.0001), FDLQI (<0.0001) and individual aspects of the PDI. The higher the PASI index, the higher the PDI, PLSI and FDLQI scores, which indicated greater impact on QOL. Among the physical and psychological factors analyzed, daily activity, employment, leisure and treatment were reported to be affected the most. Relative of female patients worries most. Conclusion: Psoriasis markedly worsens the global well-being of patients and their cohabitants, who experienced an impairment of their quality of life and higher levels of anxiety and depression.

Determinants of quality of life in patients with psoriasis attending the dermatology outpatient clinic in a tertiary care center: A cross-sectional study

Objectives: (1) To assess the clinical variables adversely affecting the quality of life (QoL) in patients with psoriasis and (2) to study the correlation between the clinical severity of psoriasis and the extent of impact of psoriasis on the QoL of the patient. Materials and Methods: After obtaining clearance from the Institutional Ethics Committee and written informed consent from individual study subject, consecutive patients with psoriasis above 18 years attending the dermatology outpatient department of a tertiary referral center from January 2015 to December 2015 were included in this cross-sectional study. Clinical severity of the disease was assessed using psoriasis area severity index (PASI). The QoL was assessed using psoriasis disability index (PDI) questionnaire. Results: There was a significant correlation between the clinical severity score and the total PDI score (P < 0.001). In PDI, the work-related questions scored the maximum (5/9, 55.5%) followed by the daily activities related questions (6.06/15, 40.4%). Patients with early age of onset, history of addiction, and history of itching had high PDI scores, but a statistically significant association was noted only for itching. There was no statistically significant association for both mean PASI and PDI scores with gender, marital status, employment status, and family history of psoriasis in our study. Limitations: Small sample size and the study conducted in a referral hospital not reflecting the status in the community were the major limitations of our study. Conclusion: Assessment of psoriasis severity should include both clinical and psychological measures. Pharmacological intervention along with psychological support will bring about a better treatment outcome and help the patients to lead a better life.

Clinical and epidemiologic features of psoriasis patients in an Egyptian medical center

BackgroundIdentification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide.ObjectiveTo provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry.MethodsThis retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed.ResultsThe mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers.LimitationsDespite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry.ConclusionsThis work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences.

The quality of life and its related factors in patients with psoriasis

Background: Psoriasis is a chronic disease that may affect patients’ quality of life. We investigated the quality of life (QoL) and its related factors in psoriasis patients. Methods: In this cross-sectional study, 123 patients with psoriasis vulgaris were enrolled, who were at the age of 18-55 years. The QoL was assessed by the psoriasis disability index (PDI) questionnaire. The stress associated with psoriasis was evaluated by the psoriasis life stress inventory (PLSI) questionnaire. The severity of the disease (SoD) was measured based on the psoriasis area and severity index (PASI) score. Results: In this study, the mean age of the patients was 40.77 ± 0.73 years, and the mean duration of the disease was 8.7 ± 8.23 years. The average PASI score was 11.06, and the average PDI score was 11.98. The average PDI and PASI scores of smoker patients were significantly more than those of non-smokers (P = 0.017). There was a strong relationship between all parts of QoL and PLSI scores, as well as between PASI and PLSI (P < 0.05). Conclusions: Psoriasis reduced our patients’ quality of life. Thus, it is recommended that the QoL in psoriatic patients be evaluated. Stress management and psychological supporting methods are necessary for these patients.

Assessment of medication adherence and treatment satisfaction in Japanese patients with psoriasis of various severities.

Psoriasis is a chronic, relapsing, inflammatory keratotic skin disease. To elucidate the medication adherence and treatment satisfaction, we performed a questionnaire survey using the eight-item Morisky Medication Adherence Scale (MMAS-8) and nine-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) of 163 psoriatic patients who regularly visited hospitals or clinics. To assess the relationship between the MMAS-8/TSQM-9 outcomes and severity of psoriasis, two different clinical severity indices were used: the Psoriasis Area and the Severity Index (PASI) for disease severity and the Psoriasis Disability Index (PDI) for quality of life (QOL) impairment. The MMAS-8 score for oral medication was significantly higher than that for topical medication. The oral and topical MMAS-8 scores were significantly correlated with the PDI score, but not with the PASI score, indicating that QOL impairment lowered treatment motivation. All of the TSQM-9 domain scores (effectiveness, convenience and global satisfaction) were significantly correlated with both the PASI and PDI scores, suggesting that patients whose skin and QOL conditions were under good control had high satisfaction with treatment. Patients treated with biologics had higher satisfaction than those treated with non-biologics.

Evaluation of fatigue and its correlation with quality of life index, anxiety symptoms, depression and activity of disease in patients with psoriatic arthritis.

BackgroundPsoriatic arthritis is associated with psychosocial morbidity and decrease in quality of life. Psychiatric comorbidity also plays an important role in the impairment of quality of life and onset of fatigue.ObjectivesThis study aimed to assess the prevalence of fatigue in psoriatic arthritis patients and to correlate it to quality of life indexes, functional capacity, anxiety, depression and disease activity.Patients and methodsThis cross-sectional study was performed on outpatients with psoriatic arthritis. Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F; version 4) was used to measure fatigue; 36-Item Short Form Health Survey (SF-36) and Psoriasis Disability Index (PDI) to measure quality of life; Health Assessment Questionnaire (HAQ) to assess functional capacity; Hospital Anxiety and Depression (HAD) scale to measure anxiety and depression symptoms; Psoriasis Area and Severity Index (PASI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI) to evaluate clinical activity.ResultsIn all, 101 patients with mean age of 50.77 years were included. The mean PDI score was 8.01; PASI score, 9.88; BASDAI score, 3.59; HAQ score, 0.85; HAD – Anxiety (HAD A) score, 7.39; HAD Depression (HAD D) score, 5.93; FACIT–Fatigue Scale (FACIT-FS) score, 38.3 and CDAI score, 2.65. FACIT-FS was statistically associated with PASI (rs −0.345, p<0.001), PDI (rs −0.299, p<0.002), HAQ (rs −0.460, p<0.001), HAD A (rs −0.306, p=0.002) and HAD D (rs −0.339, p<0.001). The correlations with CDAI and BASDAI were not confirmed. There was statistically significant correlation with all of the domains of SF-36 and FACIT-F (version 4).ConclusionPrevalence of fatigue was moderate to intense in <25% of patients with psoriatic arthritis. Fatigue seems to be more related to the emotional and social aspects of the disease than to joint inflammatory aspects, confirming that the disease’s visibility is the most disturbing aspect for the patient and that “skin pain” is more intense than the joint pain.

Biomolecular index of therapeutic efficacy in psoriasis treated with anti-TNF-α agents.

Clinical or quality of life assessments are currently available for psoriasis severity evaluation and therapeutic response. Laboratory scores focused to measure and follow treatment efficacy are lacking at present. A microscopic and biomolecular score was designed to monitor skin disease severity and clinical response to anti-psoriatic treatments. A susceptibility gene analysis on cellular retinoic acid binding protein-II (CRABP-II), acting on keratinocyte differentiation, was also performed. A Molecular Index of Therapeutic Efficacy (MITE) was defined by assembling morphometric/semiquantitative measurement of epidermal thickness, immunohistochemical Ki-67, keratin 17 and CRABP-II expression of lesional and non-lesional psoriatic skin biopsies before and after anti-tumor necrosis factor (TNF) α therapies. A 0-12 MITE score was correlated with Psoriasis Area and Severity Index (PASI) and Psoriasis Disability Index (PDI) scores and inflammation. Three CRABP-II SNPs were analyzed by TaqMan assay. All parameters were highly expressed in psoriatic lesions and reduced after 12 weeks of anti-TNF-α treatments. MITE score strongly correlated with PASI and PDI values either before or after therapies (P<0.001 and P<0.001, respectively). Conversely, MITE values did not change after treatments of non-responder patients. CRABP-II did not result in a psoriatic susceptibility gene for the SNPs probes analyzed. MITE score variations corresponded to the patients' clinical improvement following anti-TNF-α treatments, with significant statistical correlation among MITE, PASI and PDI scores. If confirmed in a larger series and/or in different hyperproliferative and inflammatory dermatoses, MITE score could be proposed as additional monitoring system to evaluate treatment protocols in skin disorders and targeted biomolecular pathways supporting clinical efficacy.

HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series

Carriage of the HLA-Cw*0602 allele is associated with a particular set of clinical features and treatment responses in psoriasis. Tonsillectomy can improve psoriasis. We sought to evaluate whether HLA-Cw*0602 predicts a favorable outcome after tonsillectomy of patients with psoriasis. This prospective case series followed up 28 tonsillectomized patients with plaque psoriasis for 24months. The Psoriasis Area and Severity Index, Psoriasis Disability Index, and Psoriasis Life Stress Inventory were used for assessment. Tonsils were swabbed for bacteria and patients genotyped for HLA-Cw*0602. After tonsillectomy, HLA-Cw*0602 homozygotes showed significantly more improvement, compared with heterozygous and HLA-Cw*0602-negative patients. Thus, Psoriasis Area and Severity Index score was reduced by 82% in the homozygous patients compared with 42% and 31%, respectively (P<.001), Psoriasis Disability Index score improved by 87% compared with 38% and 41%, respectively (P<.001), and Psoriasis Life Stress Inventory score was 82% reduced compared with 60% and 54%, respectively (P<.001). The homozygotes more often had psoriasis onset associated with a throat infection (P=.007) and an increased frequency of streptococcal throat infections per lifetime (P=.038). Few patients were included and some data were retrospective. Homozygous HLA-Cw*0602 carriage in plaque psoriasis may predict a favorable outcome after tonsillectomy.

Identification of psoriatic patients at risk of high quality of life impairment

Psoriasis is a systematic chronic disease with large influence on patients' quality of life (QoL). The aim of this study was to assess the QoL of patients with psoriasis using generic, dermatology-specific and psoriasis-specific instruments simultaneously, to investigate the relationships between dimensions or subscales of the questionnaires and to identify categories of patients at risk of a high QoL impairment. The study comprised 100 consecutive patients with psoriasis treated at the Department of Dermatology, Clinical Center "Zvezdara", Belgrade, from January to December 2011. Three QoL questionnaires were administered: the EuroQol-5D (EQ-5D), the Dermatological Life Quality Index (DLQI) and the Psoriasis Disability Index (PDI). The Psoriasis Area and Severity Index was used in evaluating disease severity. According to our results the QoL of psoriatic patients was impaired (the overall DLQI and PDI scores were 10.5 ± 7.2 and 13.4 ± 8.7, respectively, while EQ visual analog scale score was 48.8 ± 25.1). The most predictive factor of QoL impairment was disease severity, followed by sole and nail involvement. Psoriatic arthritis and bleeding were also associated with impaired QoL. Significant correlations between the instruments used in this study were in the expected directions. Mainly strong and moderate significant correlations ranging 0.26-0.84 were seen between DLQI and PDI instruments. A detailed approach to QoL assessment may give to the dermatologist useful information that could be of help in identifying patients belonging to categories at risk of high QoL impairment due to psoriasis, thus guiding them in clinical practice.

Reliability and validity of the Chinese version of the Psoriasis Disability Index (PDI) in Chinese patients with psoriasis

BackgroundThe Psoriasis Disability Index (PDI) is a widely used instrument to measure the impact of psoriasis on patients. There has not been psychometric evaluation of the Chinese version of PDI. The aim of this study was to evaluate its reliability and validity among Chinese patients with psoriasis.MethodsA multi-center, cross-sectional study was conducted at 9 hospitals including patients aged 18 years and over. Reliability was determined by internal consistency using Cronbach’s alpha. Validity was assessed through convergent validity and known groups validity. Dimensionality of the PDI was examined by exploratory factor analysis in working patients and nonworking patients respectively.ResultsIn all, 831 patients were studied. Internal consistency of the PDI was satisfactory. Cronbach’s alpha coefficient was 0.91 for the total score and over 0.70 for each subscale of the PDI. Evidence of convergent validity of the PDI was proved by excellent and moderate to good correlations with the Dermatology Life Quality Index (DLQI) and four subscales of the Short Form-36 (SF-36) (role-physical, bodily pain, social functioning, and role-emotional): r = 0.51-0.78. Known groups validity was confirmed that the PDI score discriminated well among patients with different severity of psoriasis. The dimensionality of the PDI was determined by the presence of two-factor structure for working patients and three-factor structure for nonworking patients which accounted for 57.3% and 62.3% of the variance respectively.ConclusionThe Chinese version of the PDI is a reliable and valid instrument to assess the impact of psoriasis on patients’ lives and could be used in future quality of life assessment of Chinese patients with psoriasis.

Impact of ustekinumab on health‐related quality of life in Japanese patients with moderate‐to‐severe plaque psoriasis: Results from a randomized, double‐blind, placebo‐controlled phase 2 / 3 trial

This study evaluates the effect of ustekinumab on health-related quality of life (HRQoL) in Japanese patients with moderate-to-severe plaque psoriasis through 64 weeks. A total of 158 patients were randomized to receive subcutaneous injections of ustekinumab 45 mg (n = 64) or 90 mg (n = 62) at weeks 0, 4, and every-12-weeks, or placebo (n = 32) with crossover to ustekinumab at week 12. Secondary study endpoints included change in Dermatology Life Quality Index (DLQI) at week 12. Other assessments included the 36-item Short Form health survey to assess Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and Psoriasis Disability Index (PDI), a psoriasis-specific instrument to assess HRQoL. Baseline demographic and disease characteristics were similar across randomized treatment groups. Ustekinumab-treated patients had significantly greater mean improvements in DLQI from baseline to week 12 (45 mg: 8.0 ± 6.5; 90 mg: 7.4 ± 6.5) than placebo-treated patients (0.3 ± 5.3; P < 0.0001 for each), and these improvements were maintained through week 64. Also at week 12, significant improvements from baseline in PDI scores were observed in ustekinumab-treated patients (45 mg: 8.6 ± 9.6; 90 mg: 12.0 ± 11.8) compared with placebo-treated patients (-0.1 ± 4.2). Improvements in the PCS (45 mg: 7.8 ± 14.5; 90 mg: 5.1 ± 12.0) and MCS (45 mg: 5.3 ± 9.8; 90 mg: 5.8 ± 10.5) scores were also observed in ustekinumab-treated patients at week 12. Placebo-treated patients who crossed-over to ustekinumab achieved improvements in HRQoL comparable to those observed in patients originally randomized to ustekinumab. Ustekinumab significantly improves HRQoL in Japanese patients with moderate-to-severe plaque psoriasis through week 64.

A study of psoriasis and quality of life in a tertiary care teaching hospital of Kottayam, Kerala

Background:Psoriasis is a chronic skin disease which has an impact on health-related quality of life (QoL). The psoriasis disability index (PDI) is a simple 15-item questionnaire which is used to assess overall psoriasis disability.Objectives:(1) To assess the health-related QoL among patients with psoriasis, attending dermatology OPD of Medical College Hospital, Kottayam. (2) To find out the association of QoL with age and gender.Materials and Methods:This was a descriptive case series study conducted in Dermatology OPD of Medical College Hospital, Kottayam, Kerala. Psoriasis patients attending the Dermatology OPD of Medical College Hospital for 2 months were assessed.Results:Out of the total 32 patients, 56.2% were males, whose mean age was 45; 72% were married, 47% had education above plus two and were employed. Also, 34% had income above Rs. 3000 per month. Among the PDI subsets, daily activities were affected the most (90.6%), followed by work (84.4%), leisure activities (71.9%), problems with treatment (68.7%) and the least affected was personal relations (62.5%). Overall PDI score (median 14.5, interquartile range 4.5–22) showed that the QoL was affected in 75% of which 9.4% were mild (score < 9), 31.2% were moderate (score 10–18) and 34.4% were severe (score > 18). There was no association between the total PDI score and age or gender.Conclusion:QoL was affected in 75% of psoriasis patients. There was no association between QoL and age or gender.

Positive Effect of Modified Goeckerman Regimen on Quality of Life and Psychosocial Distress in Moderate and Severe Psoriasis

Psoriasis is a chronic inflammatory skin disease with a profound effect on quality of life and psychosocial stress. The relationship between clinical improvement and psycho-social impact after treatment is complex. The objective of this study was to compare changes in quality of life and psychosocial distress, and overall cost-effectiveness, in patients with psoriasis receiving the modified Goeckerman regimen (UV irradiation and coal tar) with those receiving conventional treatment. Patients with moderate/severe psoriasis receiving the Goeckerman regimen were followed from admission to discharge. Clinical severity, was evaluated weekly using the Psoriasis Area and Severity Index (PASI). Psoriasis Disability Index (PDI) and Hospital Anxiety and Depression Scale (HADS) questionnaires were applied at admission and one month after discharge. Thirty-six patients with psoriasis receiving conventional treatment and 48 patients receiving the Goeckerman regimen were recruited to the study. The mean PASI score in the Goeckerman group decreased from 27.1 to 6.9 and PDI scores decreased from 25.3 to 13.8. HADS scores for anxiety and depression decreased significantly from 9.8 to 6.3 and 9.1 to 6.8, respectively. In comparison with conventional therapy, the modified Goeckerman regime showed similar clinical efficacy, with additional benefits in improving overall quality of life and psychosocial distress in patients with moderate/severe psoriasis, and more cost-effectiveness.

A Randomized Comparison of Methods of Selecting Narrowband UV-B Starting Dose to Treat Chronic Psoriasis

To compare narrowband UV-B (TL-01 lamp) phototherapy for psoriasis with individual patient starting doses based on minimal erythemal dose (MED) determination vs a standard fixed starting dose and to compare the efficacy of 70% of MED vs 50% of MED starting dose regimens. Single-center, randomized, double-blind, clinical trial. Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland. A total of 210 adult patients (207 of skin phototypes I to III) referred for narrowband UV-B to treat chronic psoriasis. The study was designed to have 90% power to detect a difference of 3 or more treatments to clearance and/or minimal residual activity (MRA) between groups. Narrowband UV-B phototherapy was given according to 3 standard regimens, differing only by starting dose selection method. The randomly allocated starting doses were (1) a fixed starting dose, (2) 70% of individual MED, and (3) 50% of individual MED. All patients were MED tested to ensure blinding and for safety reasons. The number of treatments to clearance and/or MRA of psoriasis was the primary efficacy outcome measure, with changes in Psoriasis Area and Severity Index and Psoriasis Disability Index scores as secondary measures. Adverse effects were recorded. There were no significant differences in the number of treatments to clearance and/or MRA across all 3 groups or in the percentages achieving clearance in each group. More uncomfortable erythemas occurred in the 50% of MED starting dose group (39%) than in the 70% of MED starting dose group (24%) or the fixed starting dose group (24%) (P=.07). The methods of determining the starting dose in this predominantly skin phototype I and II population, treated 3 times weekly, with a 20% followed by 10% incremental reduction in dose, did not significantly influence the effectiveness of treatment. Had there been a clinically important difference in efficacy, we would have expected to identify this. Thus, basing starting dose on individual MED assessments may not influence the treatment's efficacy in a skin phototype I to III population, although it remains important for patient safety. It remains possible that in populations containing individuals with a broader range of erythemal sensitivity, basing the starting dose on MED testing could have an important impact on treatment effectiveness. isrctn.org Identifier: ISRCTN84614024.

The Psoriasis Family Index: Preliminary Results of Validation of a Quality of Life Instrument for Family Members of Patients with Psoriasis

Background: Psoriasis can have a major impact on the lives of patients, the members of their families and their partners. Objectives: To develop and validate a disease-specific instrument to measure the secondary impact of psoriasis on the health-related quality of life (HRQoL) of family members of psoriasis patients. Methods: The development of the new questionnaire involved a number of different stages: qualitative interviews with family members/partners, formulation of the first draft, refinement, initial validation, further refinement and finally revalidation of the questionnaire. Results: Items for the measure were generated from the content analysis of interview transcripts. The psychometric evaluation of the final draft of the Psoriasis Family Index (PFI-15) was carried out in a new cohort of participants. The PFI-15 demonstrated high internal consistency (Cronbach’s α = 0.86) and high test-retest reliability (intraclass correlation coefficient = 0.93). The construct validity was assessed by testing a number of a priori hypotheses about its construct; a moderate to strong correlation was seen between families’ PFI scores and patients’ Dermatology Life Quality Index scores (r = 0.54, p < 0.01) and Psoriasis Disability Index scores (r = 0.59, p < 0.01), and between families’ PFI scores and patients’ Psoriasis Area and Severity Index scores (r = 0.43, p < 0.01). Conclusions: The PFI is a simple and practical measure to assess the HRQoL of family members/partners of patients with psoriasis.

Impact of psoriasis on quality of life in Iran

The Psoriasis Disability Index (PDI) questionnaire is a widely used instrument to measure psychological morbidity in plaque-type psoriasis patients. This study aimed to validate the Persian version of the PDI and to evaluate the impact of psoriasis on quality of life (QOL). The English language version of the PDI was translated into Persian (Iranian official language) and was used in this study. The questionnaire was administered to a consecutive sample of 125 chronic plaque-type psoriasis patients and statistical analysis was performed to evaluate the impact of psoriasis on QOL. The other health-related QOL assessment tool included the Persian version of the Dermatology Life Quality Index (DLQI). Overall, 125 patients who had received the PDI and DLQI completed all the questions. Reliability analysis showed a satisfactory result (Cronbach's a coefficient=0.92 and 0.79 for PDI and DLQI, respectively). There was a strong statistical correlation between mean PDI and DLQI scores, with mean Psoriasis Area and Severity Index (PASI) (P=0.005 and 0.02). Also, a significant correlation coefficient existed between DLQI and PDI (r=0.94). The higher the PASI index, the higher the PDI and DLQI scores, which indicated greater impact on QOL. In the patients with lesions on visible exposed skin areas, the correlation was statistically significant (P=0.002 and 0.01). The Persian PDI is an acceptable, reliable and valid measure of psychological distress, with more suitable content validity than DLQI for assessment of impact of psoriasis on QOL among psoriasis patients. Data provided may improve the physicians' awareness of the importance of the patients' QOL.

European patient perspectives on the impact of psoriasis: the EUROPSO patient membership survey

EUROPSO (European Federation of Psoriasis Patient Associations) undertook a Europe-wide survey examining quality of life and patients' perspectives on treatment and their disease. To explore patients' perspectives of psoriasis on their lifestyle and well-being and to gain insight into the effectiveness of and satisfaction with currently available therapies for psoriasis. Self-administered questionnaires (n = 50,500) were mailed to members of psoriasis patient associations in Belgium, the Czech Republic, Finland, France, Germany, Italy and the Netherlands. Responses were received from 18,386 patients (36%), of whom 17,990 had psoriasis. Mean age at onset of psoriasis was 30.5 years, 59% of respondents had self-reported moderate to severe psoriasis (3% or greater body surface area involvement) and 30% had been diagnosed with psoriatic arthritis. The mean Psoriasis Disability Index score was 12.2 (25% of the maximum score), increasing to 21 (44%) in patients with more than 10% body surface area involvement. The greatest impact was on activities of daily living, especially affecting clothing choice, bathing routine and sporting activities. Overall, 77% replied that psoriasis was a problem or a significant problem. While patients were satisfied with the information and care from their dermatologist (40% highly satisfied), available treatment options were less satisfactory, with over 70% reporting only low to moderate satisfaction. This is the largest survey of people with psoriasis in Europe and shows that psoriasis has a profound impact on quality of life.

Validación de la versión española del cuestionario Psoriasis Disability Index en la evaluación de la calidad de vida en pacientes con psoriasis moderada-grave

Introduction To assess the measurement properties of the Spanish version of the Psoriasis Disability Index (PDI) quality of life questionnaire for patients with moderate or severe psoriasis in ordinary clinical practice. Patients and methods A study was carried out with 294 patients with moderate or severe psoriasis who had received therapeutic treatment. Sociodemographic and clinical variables were collected and the PDI and EuroQoL-5D questionnaires were administered at the baseline visit, and at 3 and 6 months later. The feasibility (percentage of patients responding to the questionnaire), validity of the construct, internal reliability and sensitivity to change were analyzed. Results Feasibility: 98.6 % of the patients answered over 80% of the questions on the questionnaire. Validity of the construct: the PDI scores were correlated with the scores obtained in the Psoriasis Area Disability Index (PASI) (r = 0.33) and the Visual Analogue Scale (VAS) of the EQ-5D (r = −0.41) (p < 0.01). Longitudinal validity: the PDI questionnaire score after 6 months of treatment was correlated with the changes in the PASI index and the VAS (r = 0.39 y −0.51). Reliability: the internal consistency of the dimensions was high (Cronbach's alpha = 0.89). Sensitivity to changes: the size of the effect corresponding to the changes experienced by the patients who noticed an improvement in the severity of their psoriasis during the period between visits was 0.95. Conclusion The Spanish version of the PDI has proven to be reliable, valid and sensitive to changes for use with patients with psoriasis in the Spanish population, although the test-retest reliability should be analyzed for clinically stable patients.

Traditional systemic treatments have not fully met the needs of psoriasis patients: Results from a national survey

Many psoriasis patients are dissatisfied with current therapies. However, patient-centered levels of satisfaction with individual treatments have not been well described. To assess patients' satisfaction with 4 systemic treatment options available before 2002. We used data from a recent national survey. Psoriasis patients were randomly recruited from the general US population, members of the Psoriasis Foundation, and persons who contacted the Psoriasis Foundation but did not join. The interview included questions about use and satisfaction with specific Psoriasis therapy. Of 1197 psoriasis patients interviewed, 311 (26%) indicated current or past use of methotrexate, psoralen plus ultaviolet A (PUVA), cyclosporin, and/or acitretin (users). Compared with those who had never used any of these systemic therapies, users reported more extensive disease (adjusted odds ratio [OR] = 2.90, 95% confidence interval [CI] = 1.87-4.49) and higher Psoriasis Disability Index scores (category V: adjusted OR = 2.31, 95% CI = 1.22-4.36). After adjusting for these variables, more than one third of patients were dissatisfied with each therapy, except for PUVA (14%). Patients were most satisfied with methotrexate and PUVA. However, less than 40% of the users indicated they were very satisfied with any of the 4 therapies assessed. Only 10% of persons who ever used cyclosporin were currently using it. In a paired analysis, cyclosporin users were significantly less satisfied with cyclosporin than with other therapies ( P = .01). For most patients, none of the 4 systemic therapies widely utilized in 2002 for psoriasis were highly satisfactory. If we are to learn whether new treatments satisfy patients' needs, long term, prospective, comparative studies of heterogeneous patient populations that include patients' assessments are needed.