Self-Administered Psoriasis Area Research Articles

Mindfulness and Meditation for Psoriasis: A Systematic Review.

Psoriasis is a chronic, recurrent inflammatory skin condition in which flares are commonly associated with stress. One important non-pharmacological method for managing stress in patients with psoriasis is mindfulness and/or meditation. The objective of this review is to provide an update on research studies investigating the role of mindfulness and meditation in treating psoriasis symptoms, severity, and quality of life. Of six randomized control trials (RCTs) identified, five demonstrated improvement in self-administered psoriasis area and severity index (saPASI) after 8 or 12 weeks of guided meditation. One RCT and one non-randomized control trial reported mental health benefits in psoriasis patients following guided meditation. These results suggest that meditation can be used as a tool to improve both psoriasis skin severity and patient quality of life in the short term. More research is needed to evaluate the effect of meditation on psoriasis severity and quality of life in the long term.

Influence of psoriasis lesions' location and severity on psychosocial disability and psychopathology. Observational study and psychometric validation of the SAPASI Portuguese version

ObjectivesThe psychosocial impact of psoriasis is well documented. However, the contributing role of clinical disease characteristics is not satisfactorily explored. This study aimed to validate the Self-administered Psoriasis Area and Severity Index (SAPASI) to a Portuguese population (SAPASI-PT) and to perform its cross-validation, assessing how the results will generalize to an independent data set, with the Psoriasis Area and Severity Index (PASI), in order to assess the influence of psoriasis' severity on psychosocial disability and psychopathology. MethodsA cross-sectional study with 228 patients with psoriasis was carried out. Data was collected through a sociodemographic and clinical questionnaire, SAPASI-PT, the Psoriasis Disability Index (PDI) and the Brief Symptoms Inventory (BSI). The cultural and linguistic adaptation of SAPASI to a Portuguese version and the cross validation with PASI was carried out. Multiple associations between psychosocial disability, psychopathology and severity, discomfort and location of lesions were investigated through logistic regression models. ResultsA good adjustment model for SAPASI-PT is found. Also, associations between psychosocial disability, psychopathology and the psoriasis severity and discomfort are found. The existence of lesions is positively associated with the severity of the disease. Patients with lesions in hands or genitals are those reporting a greater discomfort. The presence of lesions in hands is positively associated with PDI, i.e., with leisure and with treatment, marginally. Additionally, patients scoring higher in the personal dimension are found to have a significantly greater percentage of lesions in the genitals. ConclusionsThe psoriasis severity and location of lesions are important determinants of patients´ quality of life. Lesions on face, hands and genitals are associated with a higher impact on psychosocial wellbeing of patients. Psychological counselling should be considered within psoriasis treatment context in patients with the described disease manifestations.

Effectiveness of Online vs In-Person Care for Adults With Psoriasis

ImportanceInnovative, online models of specialty-care delivery are critical to improving patient access and outcomes.ObjectiveTo determine whether an online, collaborative connected-health model results in equivalent clinical improvements in psoriasis compared with in-person care.Design, Setting, and ParticipantsThe Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial is a 12-month, pragmatic, randomized clinical equivalency trial to evaluate the effect of an online model for psoriasis compared with in-person care. Participant recruitment and study visits took place at multicenter ambulatory clinics from February 2, 2015, to August 18, 2017. Participants were adults with psoriasis in Northern California, Southern California, and Colorado. The eligibility criteria were an age of 18 years or older, having physician-diagnosed psoriasis, access to the internet and a digital camera or mobile phone with a camera, and having a primary care physician. Analyses were on an intention-to-treat basis.InterventionsParticipants were randomized 1:1 to receive online or in-person care (148 randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity. All participants were exposed to their respective interventions for 12 months.Main Outcomes and MeasuresThe prespecified primary outcome was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and in-person groups. Prespecified secondary outcomes included body surface area (BSA) affected by psoriasis and the patient global assessment score.ResultsOf the 296 randomized participants, 147 were women, 149 were men, 187 were white, and the mean (SD) age was 49 (14) years. The adjusted difference between the online and in-person groups in the mean change in the self-administered PASI score during the 12-month study period was –0.27 (95% CI, –0.85 to 0.31). The difference in the mean change in BSA affected by psoriasis between the 2 groups was –0.05% (95% CI, –1.58% to 1.48%). Between-group differences in the PASI score and BSA were within prespecified equivalence margins, which demonstrated equivalence between the 2 interventions. The difference in the mean change in the patient global assessment score between the 2 groups was –0.11 (95% CI, –0.32 to 0.10), which exceeded the equivalence margin, with the online group displaying greater improvement.Conclusions and RelevanceThe online, collaborative connected-health model was as effective as in-person management in improving clinical outcomes among patients with psoriasis. Innovative telehealth delivery models that emphasize collaboration, quality, and efficiency can be transformative to improving patient-centered outcomes in chronic diseases.Trial RegistrationClinicalTrials.gov Identifier: NCT02358135

Psychological Distress, Alexithymia and Alcohol Misuse in Patients with Psoriasis: A Cross-Sectional Study.

This study investigates (a) the prevalence of psychological distress, alexithymia and alcohol misuse in psoriasis patients; and (b) the relationship between psoriasis severity, alexithymia, alcohol and psychological distress in patients with psoriasis. A cross-sectional study was conducted. Outpatients (n = 184) with moderate to severe psoriasis completed a psychological screening battery. Measures included the Hospital Anxiety and Depression Scale, the Penn State Worry Questionnaire, the twenty-item Toronto Alexithymia Scale, the Dermatology Life Quality Index, the Psoriasis Area and Severity Index, the Self-Administered Psoriasis Area and Severity Index, and the Alcohol Use Disorders Identification Test. Demographic, clinical details and information on knowledge of psychosocial issues, alcohol and confidence on coping with distress and talking to others about psoriasis was also gathered. Alexithymia was associated with anxiety, depression and worry; subjective psoriasis severity was associated with worry. Alcohol misuse was related to anxiety and worry, but not to depression. Appropriate identification and treatment of alcohol difficulties and psychological distress of patients with psoriasis is needed.

Emotion Regulation in Patients with Psoriasis: Correlates of Disability, Clinical Dimensions, and Psychopathology Symptoms.

There are known connections between emotions and psoriasis; however, we have not established a clear pathway for this association. This study aimed to explore correlates of difficulties in emotional regulation in patients with psoriasis and predict the influence of emotional regulation in psoriasis disability. Two hundred and twenty eight participants completed the Difficulties in Emotion Regulation Scale, Self-administered Psoriasis Area and Severity Index, Psoriasis Disability Index, and Brief Symptom Inventory. Spearman's correlation and a hierarchical stepwise multiple regression were carried out to analyse associations. Results indicated that patients with the most recent diagnoses experienced greater difficulty in acting in accordance with goals (r=.16, p<.05) but lesser difficulty in engaging in goal-directed behaviour (r=-.15, p<.05). Those with greater satisfaction with treatment exhibited fewer difficulties in emotional regulation (r=-.23, p<.01). The patients who experienced greater difficulty in emotional regulation perceived greater psoriasis severity (r=.15, p<.05) and disability (r=.36, p<.05), reported more psychopathological symptoms (correlations between .46 and .56), and missed work/school more frequently (r=.24, p<.05). Impulse control proved to be the strongest predictor to psoriasis disability (β=.34). The results highlighted the relationship between emotional regulation difficulty, disease characteristics, and psychological variables in psoriasis disability emphasizing the importance of including a broader approach in clinical management of psoriatic patients.

Severity and management of psoriasis within primary care.

BackgroundScottish Intercollegiate Guidelines Network and National Institute of Health and Care Excellence guidelines stress the importance of assessing patients with psoriasis for psoriatic arthritis, comorbidities associated with severe disease and quality of life (QoL).The purpose of the study was to evaluate the primary care management of psoriasis in relation to disease severity and QoL from a patient’s perspective.MethodsA cross-sectional survey of adults (≥18 years) with psoriasis managed in primary care was conducted in Scotland over 1-year (2012–2013). Patients with psoriasis were identified and invited to participate in the online/telephone survey. The questionnaires included; Dermatology Life Quality Index (DLQI), Self-Administered Psoriasis Area and Severity Index (SAPASI), Psoriasis Epidemiology Screening Tool (PEST). The primary outcome measure was DLQI. Secondary outcomes included; demographics; comorbidities; involvement of different body sites; SAPASI and PEST scores. Relationships between measures were analysed using univariate analysis.ResultsThe mean age of patients (n = 905) was 54.5 years (SD = 16.1), 436 (48.2 %) were men, and median DLQI and SAPASI scores were 4.0 and 6.0, respectively. Current psoriasis treatments were topical only (587, 64.9 %), oral medications or phototherapy (122, 13.5 %), biologics (26, 3 %) and none (156, 17.2 %). Despite SIGN recommendations, 256 of 391 patients (65.5 %) with a DLQI >5 (at least a moderate effect on QoL) had not seen a specialist during the past year. According to PEST scores, 259 patients (28.6 %) had symptoms suggestive of psoriatic arthritis requiring rheumatology referral.ConclusionNational recommendations are not being fully implemented in primary care in patients with psoriasis or psoriatic arthritis.

553 SIG-1191: A novel hydrating Cosmetic Functional Ingredient (CFI) for suborbital hyperpigmentation (under eye dark circles)

548 Effects of a natural immune modulator on plaque psoriasis N Korman, E Baron, K Gordon, S Glazer, S Phillips and JE Bernstein 1 University Hospitals, Cleveland, OH, 2 Northwestern University, Chicago, IL, 3 Northshore University Health System, Evanston, IL and 4 Elorac, Inc., Vernon Hills, IL Background: Recognition that psoriasis (PS) is a chronic inflammatory disorder, rather than a local hyperproliferative disorder, has led to the understanding that proinflammatory cytokines contribute to the initiation and/or persistence of inflammation in PS. These cytokines and their transduction pathways, include tumor necrosis factor alpha (TNF-a), various interleukins (IL), the Janus kinases and phosphodiesterase 4. Objective: To evaluate oral administration of a natural immune modulator(NIM) to patients with plaque PS receiving concomitant treatment with biological drugs, and effects of NIM on inflammatory biomarkers in treatment-naive PS patients. Methods: Nineteen (19) adult PS patients receiving a biologic (ustekinumab (9), adalimumab (7), etanercept (3)) for at least 3mo received NIM capsules qd for 8wks. Clinical benefits were assessed by a Self-Administered Psoriasis Area Severity Index (SAPASI), a patient global, and an evaluation of body surface area (BSA). Nineteen (19) PS patients without therapy for 90 days, or biological for 1yr, received NIM for 28 days. Serum TNF-a, IL-6 and IL-12 biomarkers were measured at baseline and at 28 days. Adverse effects (AE) were solicited. Results: Baseline SAPASI scores ranged from 4-60 (mean of 16.5). These scores were reduced to a mean SAPASI of 6.7 at 8wk. Of 11 patients with a baseline SAPASI>10, 91% had an 8wk PASI 50 and 55% had an 8wk PASI 75. Patient globals demonstrated that 63% of patients were Much Better or Better. Ten (10) patients (53%) had a substantial BSA decrease in. Eleven (11) of 19 patients had a decrease in serum TNF-a levels with a mean decrease of 18.6% and 10 of the 19 patients (53%) had a 47.3% mean reduction in IL-6/IL-12 serum levels. No NIM related AE were reported. Conclusions: Addition of NIM to PS patients on biologicals can provide additional clinical benefit, and the actions of the NIM may be related to its ability to inhibit a variety of inflammatory pathways critical to PS. 549 Antioxidative Activity of CSL Extracts on normal human epidermis J Shim Department of Oriental Cosmetic Science, Semyung Univ, Jecheon, Korea (the Republic of) In this study, the antioxidative effects of CSL extracts were investigated. CSL extract has the similar antioxidant activity compared to ascorbic acid by DPPH assay. To confirm the antioxidnat effect on human epiermal keratinocyte, we treated CSL extract on UVA (5 J/cm2) treated human epidermal keratinocyte. CSL extract can enhance the expression of AQP3 and HAS2 genes. And CSL extract reduced the H2O2 production by UVA treatment. To determine the cause of antioxidnat activity on human epidermal keratinocyte, we performed realtime PCR related on antioxidnat enzymes such as SODs, catalase, and GPXs. Only GPX7 mRNA expression was enhanced by CSL extract treatment. These results mean that CSL extract have radical scaveging and inducing the expression of antioxidant enzyme especially GPX7. And component analysis of CSL extract and antioxidant activity could be applicable to new functional cosmetics.

Determinants of acceptance of an illness in the case of patients suffering from psoriasis treated in the hospital and outpatient clinic settings

&lt;b&gt;Background&lt;/b&gt;&lt;br /&gt; Psoriasis is one of the most commonly occurring cutaneous conditions. In connection with its chronic character, and with the presence of defacing pathological changes on the skin, this medical condition reduces the quality of life in the physical, mental and social aspects. It is also an illness whose course is substantially influenced by psychological factors. The level of acceptance of an illness in the case of psoriasis patients may exert a significant influence on their level of adjustment to their medical condition and psycho-social functioning. The objective of this research was to estimate the level of acceptance of the illness, and to determine the correlations between acceptance of the illness and the way in which it is perceived, the exacerbation of symptoms, and the health locus of control in groups of patients with psoriasis treated in the hospital and outpatient clinic settings.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Participants and procedure&lt;/b&gt;&lt;br /&gt; The research included a group of 61 patients suffering from psoriasis. The following research tools were applied: the Acceptance of Illness Scale (AIS), the Multidimensional Health Locus of Control Scale (MHLC), the Disease Rating Scale (DRS), the Self-Administered Psoriasis Area Severity Index (SAPASI), and the Visual Analogue Scale (VAS).&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; The studied patients accepted their illness to an average degree. No significant differences were found for that variable between the studied individuals treated in the hospital setting and those treated in the outpatient clinic setting. In the group of hospitalized patients, the perception of the illness in the categories of a threat, harm, life balance disturbance and an obstacle/a loss was negatively correlated with the acceptance of it. In the group of patients treated in the outpatient clinic setting, the assessment of the illness in the categories of a threat and harm, and the subjective assessment of exacerbation of symptoms of the illness, measured using the VAS, were negatively correlated, whereas being convinced that the health locus of control was located internally was positively correlated with acceptance of the illness. The perception of an illness as an obstacle and being convinced that the health locus of control is the internal one make it possible to predict the degree of acceptance of an illness in the case of patients suffering from psoriasis.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;br /&gt; Planning psychological influences, and wanting to understand the functioning of individuals suffering from psoriasis better, it is recommendable to concentrate upon the understanding of the possible modification of the way in which the individuals in question assess their own illness, and also their own influence upon their state of health.

Distribution pattern of psoriasis, anxiety and depression as possible causes of sexual dysfunction in patients with moderate to severe psoriasis.

BACKGROUND:Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relation. However, beyond genital psoriasis, the importance of the disease's distribution patterns has not been considered.OBJECTIVES:To research sexual function in psoriasis patients and investigate the roles of anxiety, depression and psoriasis' distribution patterns in sexual dysfunction.METHODS:A comparative study matched for sex and age was performed. Eighty patients with moderate to severe psoriasis and 80 healthy controls were included. The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index.RESULTS:Psoriasis was associated with sexual dysfunction, odds ratio=5.5 (CI 95% 2.6-11.3; p<0.001). Certain distribution patterns of psoriasis, involving specific body regions, were associated with an increase in sexual dysfunction in the group presenting the disease, odds ratio 7.9 (CI 95% 2.3-33.4; p<0.001). Multivariate logistic regression analysis identified anxiety and depression, and the involvement of these specific areas, as possible independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis.CONCLUSION:This study identifies body areas potentially related to sexual dysfunction, independently of anxiety and depression, in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when choosing the treatment for psoriasis patients.

Distribution pattern of psoriasis affects sexual function in moderate to severe psoriasis: a prospective case series study.

Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relationship. However, beyond genital psoriasis, the importance of the distribution pattern of the disease has not been considered. To investigate the role of the distribution pattern of psoriasis in sexual dysfunction. A prospective case series study was carried out on 133 patients with moderate to severe psoriasis. The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. Forty-four women (mean age 42.0 ± 14.1) and 79 men (mean age 47 ± 11.7) were included in the study. Psoriasis lesions on abdomen, genitals, lumbar region, and buttocks in women and chest, genitals, and buttocks in men were associated with an increase in sexual dysfunction. Multivariate logistic regression analysis showed that the involvement of these specific areas may be independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. This is the first study identifying body areas other than genitals as potentially related to sexual dysfunction in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when deciding on treatment for psoriasis patients.

A telephone-based motivational interviewing intervention has positive effects on psoriasis severity and self-management: a randomized controlled trial.

Psoriasis is a common skin disease with extensive comorbidity risks, which may affect multiple aspects of life. Self-management is essential for skin treatment and lifestyle choices, but few disease-specific tailored self-management and educational programmes appear to be available. To evaluate the effects of a 3-month individual motivational interviewing intervention in patients with psoriasis (with a total follow-up of 6 months) after climate therapy/heliotherapy (CHT). A randomized controlled trial with 169 patients with psoriasis was conducted in the context of CHT at Gran Canaria, Spain. The main outcome measures were Self-Administered Psoriasis Area and Severity Index (SAPASI) and Health Education Impact Questionnaire (heiQ), and the secondary outcomes were illness perception, psoriasis knowledge and lifestyle change assessments. Outcomes were measured at baseline, after 3 weeks of CHT, and 3 months and 6 months later. There were significant overall treatment effects in the study group in terms of the SAPASI score, three self-management domains of heiQ and the self-efficacy scores (P < 0∙05). The lifestyle change parameters were significantly better in the study group. Illness perception differed between the groups at 3 months (P = 0∙014), and psoriasis knowledge was significantly better in the study group at 6 months (P = 0∙017). A 3-month motivational interviewing intervention following CHT had positive overall effects on disease severity, self-efficacy, psoriasis knowledge and health behaviour change. This approach has the potential to be an important complement to medical management, self-management and education in patients with psoriasis.

Nail Psoriasis, the unknown burden of disease

Psoriasis can be found at several different localizations which may be of various impact on patients' quality of life (QoL). One of the easy visible, and difficult to conceal localizations are the nails. To achieve more insight into the QoL of psoriatic patients with nail psoriasis, and to characterize the patients with nail involvement which are more prone to the impact of the nail alterations caused by psoriasis. A self-administered questionnaire was distributed to all members (n = 5400) of the Dutch Psoriasis Association. The Dermatology Life Quality Index (DLQI) and the Nail Psoriasis Quality of life 10 (NPQ10) score were included as QoL measures. Severity of cutaneous lesions was determined using the self-administered psoriasis area and severity index (SAPASI). Patients with nail psoriasis scored significantly higher mean scores on the DLQI (4.9 vs. 3.7, P = <0.001) and showed more severe psoriasis (SAPASI, 6.6 vs. 5.3, P = <0.001). Patients with coexistence of nail bed and nail matrix features showed higher DLQI scores compared with patients with involvement of one of the two localizations exclusively (5.3 vs. 4.2 vs. 4.3, P = 0.003). Patients with only nail bed alterations scored significant higher NPQ10 scores when compared with patients with only nail matrix features. Patients with psoriatic arthritis (PsA) and nail psoriasis experiences more impairments compared with nail psoriasis patients without PsA (DLQI 5.5 vs. 4.3, NPQ10 13.3 vs. 7.0). Females scored higher mean scores on all QoL scores. Greater attention should be paid to the possible impact nail abnormalities have on patients with nail psoriasis, which can be identified by nail psoriasis specific questionnaires such as the NPQ10. As improving the severity of disease may have a positive influence on QoL, the outcome of QoL measurements should be taken into account when deciding on treatment strategies.

Clinical and economic impact of etanercept in real-life: A prospective, non-interventional study of etanercept in the treatment of patients with moderate to severe plaque psoriasis in private dermatologist settings (ESTHER)

Real-life data on the therapeutic effectiveness and costs of etanercept are scarce. To assess the clinical and economic impact of etanercept in patients with psoriasis in Denmark and Norway. This prospective, non-interventional study in a private dermatologist care setting in Denmark and Norway included patients ≥18 years with moderate to severe plaque psoriasis, selected for treatment with etanercept. Assessments during 1 year from etanercept initiation included Dermatology Life Quality Index (DLQI), Self-Administered Psoriasis Area and Severity Index (SAPASI) and adverse events. Direct and indirect costs were calculated. 163 subjects were enrolled. Baseline mean SAPASI was 19.1 . Proportion of patients with ≥50% decrease in SAPASI from baseline was 85% and 81% at weeks 24 and 52. DLQI decreased significantly from 11.4 (7.0) to 3.2 (4.3) and 3.7 (4.6) at weeks 24 and 52. Total annual costs increased from 78,000 to 286,000 DKK (p<0.0001), mainly due to the cost of etanercept. Outpatient-care costs and loss-of-productivity costs decreased from 9,500 to 5,000 (p = 0.0002), and from 33,000 to 18,000 DKK (p = 0.0105), respectively. The decrease in costs was more pronounced in patients who also had psoriatic arthritis. Cost increase was greatest during the first 6 months. Etanercept treatment was associated with decreased psoriasis severity and improved quality of life. Cost increase was driven by medication, while costs of outpatient care and loss-of-productivity decreased. Maintained improved quality of life was accompanied by decreasing cost during the second 6 month period of etanercept treatment. There were no new safety signals reported.

A novel, web-based, psychological intervention for people with psoriasis: the electronic Targeted Intervention for Psoriasis (eTIPs) study

Psychological morbidity and reduced quality of life are common and linked with nonadherence to medication in psoriasis. Access to psychological therapy is often poor with long waiting times. Cognitive behavioural therapy (CBT) is a well-accepted therapy for psychological disorders and is particularly effective when tailored to address condition-specific concerns. To determine whether an electronic CBT intervention for Psoriasis (eTIPs) would reduce distress, improve quality of life and clinical severity in patients with psoriasis. This was a wait-list, randomized trial of immediate intervention vs. usual care. Self-assessed psoriasis severity (Self-Administered Psoriasis Area and Severity Index), distress (Hospital Anxiety and Depression Scale) and quality of life (Dermatology Life Quality Index) were measured before and after intervention. Analysis was based on complete cases and all cases using multiple imputation to substitute missing values. Anxiety scores between groups were significantly reduced (P < 0·05) for complete cases only; the mean (SD) scores were: intervention 7·6 (3·6) at baseline and 6·1 (3·5) at follow-up vs. control 8·3 (3·5) at baseline and after intervention 8·1 (4·4) (P = 0·004). Depression scores did not change; the experimental group scores at baseline were 5·0 (4·2) and after intervention 4·0 (3·7) vs. control group at baseline 5·2 (3·4) and after intervention 4·9 (3·8). Psoriasis severity scores did not change: baseline scores for the experimental group were 7·5 (6·0) and after intervention 6·5 (8·5) vs. the control group before 8·3 (6·3) and after 7·6 (6·1) (not significant). Quality-of-life scores improved in both analyses (P < 0·05); the intervention group scores before were 6·6 (4·2) and after intervention 5·0 (5·1) vs. control before 7·4 (4·4) and after intervention 7·7 (4·5) (P = 0·042). This first online CBT intervention for people with skin disease showed improvement in anxiety and quality of life in patients with psoriasis. The results are limited by the large amount of missing data and, at this stage, online delivery cannot substitute for established methods of delivery for CBT.

Self-reported psoriasis severity and quality of life assessment at Comano spa

The relationship between quality of life (QoL) and skin lesion improvement due to psoriasis treatment has been recently underlined. Our objective was to study the self-reported disease severity reduction and QoL during spa treatments and identify predictors of psoriasis improvement. Patients were assessed before and after spa treatment with a disease-specific QoL questionnaire (Skindex-17) and self-administered psoriasis area and severity index (SAPASI). Their correlations were tested. Factors predicting a reduction in Skindex-17 or in SAPASI score were evaluated through regression analysis. Significant mean overall reductions in SAPASI (27%) and Skindex-17 scores (psychosocial: 6%; symptoms: 2%) were achieved. However, 51% of patients reporting SAPASI improvement also reported a worsened QoL. Pearson's correlation between the SAPASI and Skindex-17 scores was poor (r=0.26 for SAPASI-symptoms and r=0.40 for SAPASI-psychosocial). Logistic regression analysis identified the age of psoriasis onset before 30 years (OR=3.81, 95% CI 1.22-11.95, p=0.02) and a basal Skindex-17 symptoms value greater than 5 (OR=3.37, 95% CI 1.12-10.08, p=0.03) as predictive of both SAPASI and Skindex-17 score reductions. Age-of-onset-based stratification identifies the subset most likely to respond to spa treatment. Combining the Skindex-17 with SAPASI provides a more comprehensive patient-centered assessment. We recommend this assessment for psoriasis patients undergoing spa treatment.

Quality of Life of Psoriasis Patients before and after Balneo - or Balneophototherapy

PurposeAn observational prospective study was conducted to study the effects of hypotonic spa-water baths and narrowband ultraviolet B therapy given alone or in combination for treatment of moderate-severe psoriasis.Materials and MethodsTwo treatments were analysed: 2 weeks of balneotherapy followed by ultraviolet-B (UVB) 311-nm phototherapy (BPT) or 2 weeks of daily bath treatments of Comano water alone (BT). One hundred and eleven adult patients with moderate to severe chronic plaque psoriasis were enrolled. Quality of life (QoL) questionnaires {36-item Short Form of the Medical Outcomes Study questionnaire (SF-36) and Skindex-29} were administered at baseline and 2 months from the end of therapy. The self-administered Psoriasis Area Severity Index (SAPASI), and the General Health Questionnaire (GHQ)-12 (to assess clinical severity and psychological distress, respectively) were also recorded at the same time-periods.ResultsSAPASI was significantly reduced from 15.2 to 8.7 in BPT group and 11.6 to 7.8 in BT. A decrease of greater than 50% after therapy in SAPASI_50 score was reached by 42% and 37% of patients in the BPT and BT groups, respectively. At follow-up, both groups had better scores on all SF-36 scales (with statistically significant improvement in social functioning and mental health in the BPT group) and in all Skindex-29 scales. A statistically significant reduction of GHQ-12 positive cases was observed in the BPT group.ConclusionComano spa-water alone or in combination with phototherapy had beneficial therapeutic effects on patients with psoriasis. Although our observational study design prevents us from making meaningful comparisons between the 2 interventions, the combination of balneo and phototherapy seems to improve QoL and lessen clinical severity, and reduced the proportion of GHQ-12 positive cases.

The impact of changes in clinical severity on psychiatric morbidity in patients with psoriasis: a follow-up study

Psoriasis has a strong impact on quality of life and is correlated to psychopathological states. It is important to investigate the effect of clinical changes on psychological status. To analyse the extent of clinical change and its effect on the presence of psychiatric morbidity in a group of patients with psoriasis. All eligible adults hospitalized with psoriasis in a dermatological hospital (February 2000-February 2002) were given the self-administered Psoriasis Area and Severity Index (SAPASI) to assess clinical severity, the 12-item General Health Questionnaire (GHQ-12) to detect patients with psychological problems (defined as 'cases') and the Skindex-29 to evaluate symptoms. The same questionnaires were completed by the patients a month after hospital discharge. In our population of 414 patients, the incidence of GHQ cases becoming noncases was correlated with the SAPASI percentage improvement, ranging from 17.6% in patients with SAPASI worsened or unchanged at follow-up, to 68.2% in patients with clearance of psoriasis. Also, the proportion of patients who became GHQ noncases was much higher in patients with improvement of >/= 50% in symptoms, compared with patients with no improvement or worsening (70% vs. 32%, respectively). In a multivariate model the possible determinants of the passage from GHQ case to noncase were: SAPASI improvement, symptom improvement, no localization on the face, and gender (i.e. women were less likely to improve psychologically). The improvement in clinical severity and symptoms was associated with a decreased frequency of psychiatric disturbance. However, dermatologists should be aware that even in the presence of vast clinical improvement patients may still substantially suffer psychologically.

A new formulation of an occlusive dressing containing betamethasone valerate 0.1% in the treatment of mild to moderate psoriasis

Betamethasone valerate (BMV) is a medium-potency corticosteroid commonly used for the treatment of chronic psoriasis. Although occlusion has been shown to enhance the efficacy of BMV treatment, no ready-to-use occlusive BMV formulation is currently approved for the market. Forty-two patients with mild to moderate psoriasis and with symmetrical lesions were treated with BMV 0.1% tape and BMV 0.12% cream for 30 days in a half-side distribution. Both treatments resulted in a significant clinical improvement. Efficacy and tolerability were evaluated by comparison of pre-treatment and post-treatment psoriasis area and severity index and self-administered psoriasis area and severity index scores, and by comparison of the changes from baseline in clinical appearance and hydration. Lesions treated with BMV 0.1% tape showed higher reductions from baseline in the psoriasis area and severity index and the self-administered psoriasis area and severity index scores (61.7% and 59.3%, respectively), compared with lesions treated with BMV 0.12% cream (39.5% and 34.0%, respectively). No serious local or systemic treatment-related adverse effects were reported. Our results indicate a higher efficacy of BMV 0.1% tape compared with BMV 0.12% cream in the treatment of mild to moderate chronic plaque psoriasis.

The Self-Administered Psoriasis Area and Severity Index provides an objective measure of psoriasis severity

The Self-Administered Psoriasis Area and Severity Index provides an objective measure of psoriasis severity

Sensitivity of the Dermatology Life Quality Index to clinical change in patients with psoriasis.

Quality of life is increasingly recognized as an important outcome measure in dermatology. The Dermatology Life Quality Index (DLQI) is a self-administered questionnaire designed to measure the impact of skin diseases on patients' quality of life. To assess the responsiveness of the DLQI to variations in clinical status as measured by the Self-Administered Psoriasis Area and Severity Index (SAPASI) in a large sample of in-patients with psoriasis. The SAPASI and the DLQI were completed by 359 in-patients with psoriasis at hospital admission and 4 weeks after discharge. Changes in SAPASI scores were used to categorize patients as improved, unchanged or worsened. Next, these groups were compared with one another with regard to the change in DLQI scores. Four weeks after discharge, both mean SAPASI scores and mean DLQI scores were significantly lower than at admission (P < 0.001). In improved patients, the DLQI score decreased significantly more than in worsened patients (P < 0.001), and tended to decrease more than in unchanged patients (P = 0.07). The difference in DLQI score change between improved patients and unchanged or worsened patients grouped together was highly significant (P < 0.001); also, it remained significant or nearly significant when the analysis was performed on subsets of patients based on gender and age range. This study contributes to building evidence of validity for the DLQI, because the instrument demonstrated the ability to detect small but meaningful changes in clinical status over time in a large sample of patients with psoriasis.