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Quality of life


Impact of psoriasis on quality of life and burden of disease


It has become increasingly relevant that any measurement of quality of life should not only capture a point-in-time of the patient's life, but also cumulative disability throughout the life course of the disease


Giampiero Girolomoni MD Paolo Gisondi MD Department of Medicine, Section of Dermatology and Venereology, University of Verona, Italy


Psoriasis is a common chronic inflammatory disorder affecting approximately 2–3% of the general population.1


It can occur at any age,


although the majority of cases develop before the age of 50 years, and it is less common in children. Psoriasis is considered to be an immune-mediated inflammatory disease, and the precise nature of the auto-antigens triggering T-cell responses is being elucidated.2 Although the primary clinical manifestations are usually in the skin, it is increasingly appreciated that psoriasis is a systemic condition. Psoriasis has a strong genetic component with the majority of the patients having first- degree relatives affected. The class I major histocompatibility complex (MHC) allele HLA-Cw6 is the strongest susceptibility factor for psoriasis. Other genetic predisposing factors include molecules involved in innate and adaptive immunity.3


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Plaque psoriasis is by far the most common clinical form of the condition (90% of patients with psoriasis) and is characterised by well-delineated red and scaly plaques. The extent of involvement is variable, ranging from a few localised plaques at extensor sites to generalised involvement (Figures 1 and 2). Rarely, psoriasis may involve the whole body configuring erythroderma. Flexural (also known as inverse or intertriginous)


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characterised by an acute eruption of small (<1cm) papules of psoriasis that generally appear after a streptococcal infection. Distinctive nail changes occur in about 50% of all those affected and are more common in patients with psoriatic arthritis. About one third of patients with psoriasis are affected by psoriatic arthritis (PsA), which affects peripheral joints, entheses, the synovial sheaths of tendons and the axial skeleton. Recent evidence has been gathered indicating that PsA is erosive and deforming in approximately 40% of patients, with bone damage arising in the first years after disease onset. The early diagnosis of PsA has now become a challenging topic, as early treatment could avoid irreversible damage and joint deformities.4


Figure 1: Plaque psoriasis with limited involvement of the elbow


“Although the primary clinical manifestations are in the skin, it is increasingly appreciated that psoriasis could be a systemic condition”


psoriasis refers to plaque psoriasis at folds (that is, submammary, groin, axillary, genital and natal cleft sites) and is typically less scaly. Guttate psoriasis is


that severe psoriasis is more than skin deep, and that it is associated with metabolic and cardiovascular comorbidities including metabolic syndrome, diabetes, obesity, non- alcoholic fatty liver disease, myocardial infarction and cerebrovascular disease.5 Moderate to severe psoriasis is defined by body surface involvement and/or Dermatology Life Quality Index (DLQI) score >10. Patients with psoriasis, like those with PsA, have a decreased quality of life (QoL), and suffer from pain and functional impairment.6


Currently there


is no cure for psoriasis, and treatments have to be used throughout the patient's life, with the aim of optimising disease control. The understanding of patients with psoriasis in the context of QoL impairment is very important to ensure that treatment is tailored to meet the specific individual patient’s needs.


Evidence is increasing


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