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Quality of life


Impact on QoL


Psoriasis is associated with a significant physical and psychological burden, affecting all facets of a patient’s life – relationships, social activities, work and emotional wellbeing.7


The level of QoL


impairment in psoriasis has been shown to be comparable to that of some severe medical conditions such as cardiovascular diseases, cancer and diabetes.8


The most common symptoms reported by patients with psoriasis include itching, burning skin sensation and joint pain, in the case of PsA. Joint pain is typically complained of during bed- or resting time and is accompanied by a morning stiffness of the involved joints. Moreover, psoriasis could be associated also to fibromyalgia, which is characterised by chronic widespread pain associated with symptoms including poor sleep, fatigue and depression. Moreover, patients with psoriasis commonly have impaired psychological functioning including alexithymia, reduced self-esteem and coping ability, favouring unhealthy behaviours such as heavy drinking and/or heavy smoking. Stigma, feeling ashamed of physical appearance and social harassment associated with visible skin lesions are also very common. Patients with psoriasis have increased rates of depression and anxiety, which occurs in up to 30% of patients, and suicidal ideation, reported in up to 10% of patients.9,10 The severity of psoriasis is generally correlated with the degree of QoL impairment.11


Assessment of QoL is used


to monitor therapeutic outcomes, as endpoints in clinical trials and as criteria for selecting appropriate treatment. Indeed, a DLQI score >10 is an independent eligibility criteria for the use of systemic therapies and biologics in psoriasis by the National Institute for Health and Care Excellence and the British Association of Dermatologists.12 European national guidelines have also adopted the same criteria independently of objective disease severity score.13 Various generic, dermatology-specific and psoriasis-specific psychometric instruments have been used over the years to assess the QoL in patients with psoriasis (Table 1). However, the DLQI is the most widely used, especially in randomised controlled clinical trials, although it has some limitations.14


The


DLQI is designed to evaluate the extent to which the skin disease affects patient’s


Table 1: A selection of quality of life instruments commonly used in dermatology


Abbreviation


Generic instruments Short-Form-36


Health Assessment Questionnaire Sickness Impact Profile


World Health Organization Quality of Life


Dermatology specific instruments Skindex


Dermatology Life Quality Index Dermatology-Specific Quality of Life


The Family Dermatology Life Quality Index The Impact of Chronic Skin Disease on Daily Life Dermatology Quality of Life Scales


Psoriasis-specific instruments The Psoriasis Index of Quality of Life Psoriasis Disability Index


SF-36 HAQ SIP


WHOQOL


Skindex DLQI DSQL FDLQI ICSDL DQLS


PSORIQoL PDI


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Figure 2: Plaque psoriasis with diffuse involvement of the back


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