1
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Mathur A, Neema S, Sahu R, Radhakrishnan S. Anxiety, depression and harmful use of alcohol in severe chronic plaque psoriasis: A cross-sectional study. Med J Armed Forces India 2023; 79:464-469. [PMID: 37441302 PMCID: PMC10334124 DOI: 10.1016/j.mjafi.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background Psoriasis is a common, chronic T cell-mediated disease characterised by erythematous, scaly plaques. Psoriasis is associated with depression, anxiety, poor quality of life, harmful use of alcohol and suicidal ideation. We performed this study to find out prevalence of psychological morbidity in our patients with severe psoriasis and to know clinical variables associated with higher risk of psychological morbidity. Method This study is a cross-sectional, observational study conducted in a dermatology outpatient department (OPD) of a tertiary care centre. Study population included patients with severe psoriasis area severity index (PASI>10). Clinical and epidemiological data, Patient health questionnaire-9, Generalised anxiety disorder-7, Dermatology life quality index (DLQI) and Alcohol Use Disorders Identification Test questionnaires were recorded. Data were analysed using SPSS, version 24. Chi-square test and Spearman's rank correlation test (ρ) were performed, and p value of <0.05 was considered statistically significant. Result A total of 140 patients were included in the study and consisted of 67 men and 73 women. The median age was 44 years, median duration of disease was 10 years and median PASI was 13.6. Scoring revealed moderate-to-severe depression in 69 (49.3%) patients, moderate-to-severe anxiety in 40 (28.6%), severe impairment in quality of life in 98 (70%), harmful use of alcohol in 23 (16.4%) and suicidal ideation in 11 (7.8%) patients. Young age, recent onset, higher PASI and facial involvement show significant association with depression, anxiety and poor quality of life. Conclusion Screening for psychological morbidity should be performed in patients with severe psoriasis especially younger patients with recent onset disease. Higher DLQI points to concomitant psychological morbidity and it should be performed in all the patients.
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Affiliation(s)
- Avijit Mathur
- Medical Cadet, Armed Forces Medical College, Pune, India
| | - Shekhar Neema
- Associate Professor, Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Rajesh Sahu
- Assistant Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S. Radhakrishnan
- Brig i/c Adm, Command Hospital (Central Command), Lucknow, India
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2
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Kim SM, Ahn J, Cho YA, Sung JY, Kim CY, Yu DA, Lee YW, Won S, Choe YB. Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea. J Eur Acad Dermatol Venereol 2023; 37:75-84. [PMID: 36028994 DOI: 10.1111/jdv.18565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Psoriasis has a devastating psychological impact on patients' quality of life. However, the relationship between suicidality and psoriasis remains unclear. OBJECTIVE This study analysed and compared the risk of suicidality (suicidal ideation, suicide attempt and completed suicide) between patients with psoriasis and the general population. METHODS This nationwide, population-based, retrospective, cohort study analysed the Korean National Health Insurance Service claim data from 2005 to 2018. RESULTS The study included 348,439 patients with psoriasis aged over 18 years and with age- and sex-matched controls. The risk of suicidality was higher in the psoriasis group than in the control group [adjusted hazard ratio (aHR) 1.21; 95% confidence interval (CI), 1.18-1.24]. The aHR of suicidality was higher in the psoriatic arthritis group (aHR, 1.46; 95% CI, 1.39-1.54) than in the psoriasis-alone group (aHR, 1.17; 95% CI, 1.13-1.20). However, the severity of psoriasis and suicidality showed no correlation (mild psoriasis group: aHR, 1.22; 95% CI, 1.18-1.25; moderate-to-severe psoriasis group: aHR, 1.16; 95% CI, 1.10-1.23). CONCLUSION Patients with psoriasis have an increased risk of suicidality. In particular, the presence of arthritis in patients had a more significant effect on the risk of suicidality.
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Affiliation(s)
- Sung Min Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Juhee Ahn
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea
| | - Young Ah Cho
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Young Sung
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chang Yong Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Da-Ae Yu
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea.,Interdisciplinary Program of Bioinformatics, Seoul National University, Seoul, Republic of Korea.,RexSoft Inc, Seoul, Republic of Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
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3
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Balato A, Zink A, Babino G, Buononato D, Kiani C, Eyerich K, Ziehfreund S, Scala E. The Impact of Psoriasis and Atopic Dermatitis on Quality of Life: A Literature Research on Biomarkers. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122026. [PMID: 36556392 PMCID: PMC9782020 DOI: 10.3390/life12122026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Psoriasis (PSO) and Atopic dermatitis (AD) are common inflammatory skin diseases that affect people of all ages globally. They negatively impact the quality of life (QoL) of patients in health-related aspects such as physical, psychological and mental functioning. Here, we conducted a review of studies relating to candidate biomarkers and indicators associated with QoL impairment in PSO and AD. Data research was performed using PUBMED and SCOPUS databases from inception to September 2022. Most of the included studies reported genomic or proteomic biomarkers associated with disease activity and QoL outcomes. Sociodemographic, clinical and therapeutic factors have also been implicated in deterioration of life quality in these patients. The inclusion of clinical characteristics, QoL impairment and co-diagnosis should be considered in drug development programs, since processing biomarkers based on an increased number of features in addition to drug class and disease will intensify the value of the biomarker itself, thereby maximizing the future clinical utility as a stratification tool.
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Affiliation(s)
- Anna Balato
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, 80802 Munich, Germany
- Unit of Dermatology, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Graziella Babino
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Dario Buononato
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Charlotte Kiani
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, 80802 Munich, Germany
| | - Kilian Eyerich
- Unit of Dermatology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Dermatology and Venereology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, 80802 Munich, Germany
| | - Emanuele Scala
- Department of Dermatology and Venereology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, 17176 Stockholm, Sweden
- Correspondence:
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4
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The impact of complete clearance and almost complete clearance of psoriasis on quality of life: a literature review. Arch Dermatol Res 2022; 315:699-706. [PMID: 36336722 DOI: 10.1007/s00403-022-02420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/15/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin condition with systemic manifestations that have a detrimental impact on a patient's quality of life, affecting social, psychological, and sexual aspects of life. Complete clearance of lesions is a meaningful end goal of treatment; however, it is often difficult for patients to achieve. In this literature review, we summarized past studies that compared patients who achieved complete clearance to those who were almost clear to highlight the effect of complete clearance on psychological distress, social stigma, self-esteem, and interpersonal relationships in adult patients with psoriasis. METHODS A literature search was performed through the PubMed database using the keywords "clearance of psoriasis", "complete clearance of psoriasis", "psychological impact psoriasis", "social impact psoriasis", and "stigma of psoriasis". Age (< 18) and language (only articles written in English were included) were the only exclusion criteria to include adult patients only. The information was then collected and evaluated to compare complete clearance and almost complete clearance of psoriasis. RESULTS Of the patients with complete skin clearance (sPGA of 0), 61.4-91.1% reported a Dermatology Life Quality Index (DLQI) of 0, indicating no detectable impact of psoriasis on quality of life, compared to 45.7-48.3% who were almost clear. Patients who were completely clear felt psoriasis had less of an effect on their leisure activities and daily living compared to patients who were almost clear. Patient perceptions of disease severity also differed between the two groups, with the majority (65.5%) of those achieving complete clearance reporting a Psoriasis Symptom Inventory (PSI) of 0, which is consistent with their disease being "not at all severe", compared to 32.6% of those who were almost but not completely clear. While patients with complete clearance achieve a DLQI of 0 at a higher rate than those who have only almost complete clearance, the difference in the mean DLQI between patients with sPGA of 0 (completely clear) and sPGA of 1 (almost clear) is less than the minimal clinically important difference (MCID of 3-5) of the DLQI.
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5
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Janowski K, Steuden S. The Temperament Risk Factor, Disease Severity, and Quality of Life in Patients with Psoriasis. Ann Dermatol 2020; 32:452-459. [PMID: 33911787 PMCID: PMC7875235 DOI: 10.5021/ad.2020.32.6.452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 03/21/2014] [Accepted: 05/02/2014] [Indexed: 11/08/2022] Open
Abstract
Background Psoriasis exerts a profound negative impact on health-related quality of life (QoL). Although the severity of psoriasis is one potential variable that contributes to decreased QoL, previous studies have shown only weak or no association between measures of psoriasis severity and QoL. We hypothesized that this relationship is moderated by temperament factors. Objective We aimed to verify whether the relationship between disease severity and QoL is moderated by a constellation of temperament traits (i.e., temperament risk factors) and whether this moderation takes place via cognitive-appraisal and coping processes. Methods One hundred fifty patients with psoriasis vulgaris participated in the study. Psoriasis severity was assessed by a standardized measure, the Psoriasis Area and Severity Index (PASI), and the patients also completed a battery of psychological questionnaires assessing QoL, temperament, disease-related cognitive appraisals, and coping strategies. Results A specific constellation of temperament traits was found to moderate the strength of the association between the PASI and QoL. This constellation of temperament traits was associated with certain disease-related cognitive appraisals (i.e., threat, obstacle/loss, harm, profit, value) and emotion-focused coping strategies (i.e., self-blame, avoidance, resignation, seeking social support, and seeking information). Conclusion The constellation of temperament traits is a crucial individual variable that strongly moderates the negative impact of psoriasis severity on QoL, potentially through the activation of non-adaptive cognitive appraisals and coping strategies in susceptible individuals.
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Affiliation(s)
- Konrad Janowski
- Institute of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Stanisława Steuden
- Department of Clinical Psychology, John Paul II Catholic University of Lublin, Lublin, Poland
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6
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Fania L, Clemente A, Sampogna F, Mazzanti C, Pallotta S, Panebianco A, Sordi D, Caggiati A, Cassotta G, Tiezzi A, Cristiano L, Zecchi V, Napolitano M, Abeni D. Intralesional ultrasound‐guided combined treatment with triamcinolone plus lincomycin in hidradenitis suppurativa: A pilot study. Dermatol Ther 2020; 33:e13901. [DOI: 10.1111/dth.13901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/25/2020] [Accepted: 06/19/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Luca Fania
- First Dermatology Unit IDI‐IRCCS Rome Italy
| | - Antonio Clemente
- Department of Anesthesia and Intensive Care IDI‐IRCCS Rome Italy
| | | | | | | | | | | | | | | | | | - Lara Cristiano
- Department of Radiology IDI‐IRCCS Rome Italy
- Department of Radiology Fondazione Policlinico Universitario “A. Gemelli IRCCS”, UCSC Rome Italy
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7
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Founta O, Adamzik K, Tobin AM, Kirby B, Hevey D. Psychological Distress, Alexithymia and Alcohol Misuse in Patients with Psoriasis: A Cross-Sectional Study. J Clin Psychol Med Settings 2020; 26:200-219. [PMID: 30206746 DOI: 10.1007/s10880-018-9580-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Ourania Founta
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland.
| | - Karoline Adamzik
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Anne-Marie Tobin
- Dermatology Department, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
| | - Brian Kirby
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital and School of Health Sciences, UCD, Dublin 4, Ireland
| | - David Hevey
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
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8
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Sampogna F, Fania L, Mastroeni S, Ciccone D, Panebianco A, Abeni D. Age-specific physical and mental health status in Italian patients with hidradenitis suppurativa: a comparison with the general population. Arch Dermatol Res 2020; 313:41-47. [PMID: 32270321 DOI: 10.1007/s00403-020-02063-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/04/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
Hidradenitis suppurativa (HS) has a considerable impact on quality of life. Despite comparisons of health status between HS patients and the general population have been done, there is a need to make more meaningful comparisons, such as age-specific ones. The objective of the study was to compare age-specific physical and mental health status in Italian patients with HS to that of a representative sample of the Italian general population. We conducted a cross-sectional, observational study on consecutive HS patients. Patients' health status was measured using the 36-item Short Form Health Survey (SF-36) and in the general population using the 12-item version (SF-12). The mean scores of the physical component summary (PCS) and the mental component summary (MCS) from the two instruments were graphically compared in different age categories according to sex and clinical severity. Data were complete for 298 HS patients. Young patients with HS reported a physical and mental health status similar to that of elderly people from the general population. Even HS patients with mild-to-moderate clinical severity had a consistently worse health status than the reference population. In conclusion, HS deeply affects patients' physical and mental status, starting from a very young age. An early intervention is advisable, not only with pharmacological treatment, but also with an appropriate discussion and interaction with the patient to focus on the aspects that would reduce the psychosocial impact of their condition.
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Affiliation(s)
- Francesca Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy.
| | - Luca Fania
- 1st Dermatological Unit, IDI-IRCCS, Rome, Italy
| | - Simona Mastroeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy
| | | | | | - Damiano Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy
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9
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Sampogna F, Mastroeni S, Pallotta S, Fusari R, Uras C, Napolitano M, Abeni D. Use of the SF‐12 questionnaire to assess physical and mental health status in patients with psoriasis. J Dermatol 2019; 46:1153-1159. [DOI: 10.1111/1346-8138.15074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
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10
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Kurizky PS, Martins GA, Carneiro JN, Gomes CM, da Mota LMH. Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis. An Bras Dermatol 2019; 93:801-806. [PMID: 30484522 PMCID: PMC6256218 DOI: 10.1590/abd1806-4841.20183071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/13/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. OBJECTIVES To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. METHODS This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. RESULTS The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. STUDY LIMITATIONS Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. CONCLUSIONS QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.
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Affiliation(s)
- Patricia Shu Kurizky
- Dermatology Service, Hospital das Forças Armadas,
Brasília (DF), Brazil
- Dermatology Service, Hospital Universitário de
Brasília, Universidade de Brasília, Brasília (DF),
Brazil
| | - Gladys Aires Martins
- Psoriasis Outpatient Clinic, Hospital Universitário de
Brasília, Universidade de Brasília, Brasília (DF),
Brazil
| | | | | | - Licia Maria Henrique da Mota
- Initial Rheumatoid Arthritis Outpatient Clinic, Hospital
Universitário de Brasília, Universidade de Brasília,
Brasília (DF), Brazil
- Graduate Studies Program in Medical Sciences, Universidade de
Brasília, Brasília (DF), Brazil
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11
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Sampogna F, Puig L, Spuls P, Girolomoni G, Radtke M, Kirby B, Brunori M, Bergmans P, Smirnov P, Rundle J, Castiglia A, Lavie F, Paul C. Reversibility of alexithymia with effective treatment of moderate‐to‐severe psoriasis: longitudinal data from
EPIDEPSO. Br J Dermatol 2018; 180:397-403. [DOI: 10.1111/bjd.17259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- F. Sampogna
- Clinical Epidemiology Unit Dermatological Hospital IDI‐IRCCS FLMM Rome Italy
| | - L. Puig
- Universitat Autònoma de Barcelona Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - P. Spuls
- Department of Dermatology University of Amsterdam Amsterdam the Netherlands
| | | | - M.A. Radtke
- Universitätsklinikum Hamburg‐Eppendorf Hamburg Germany
| | - B. Kirby
- St Vincent's University Hospital Dublin Ireland
| | | | | | | | | | | | | | - C. Paul
- Toulouse University and CHU Hôpital Larrey Toulouse France
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12
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Kwan Z, Bong YB, Tan LL, Lim SX, Yong ASW, Ch'ng CC, Tan MP, Ismail R. Determinants of quality of life and psychological status in adults with psoriasis. Arch Dermatol Res 2018; 310:443-451. [PMID: 29687328 DOI: 10.1007/s00403-018-1832-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/24/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
We investigated whether disease severity and clinical manifestations were associated with depression, anxiety, stress and quality of life in adults with psoriasis. Participants were recruited from a dermatology outpatient clinic at a teaching hospital. Information on sociodemographic characteristics, disease severity, presence of arthropathy and head involvement was specifically recorded. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Quality of life and psychological symptoms were measured using the Dermatology Life Quality Index (DLQI) and the Depression Anxiety Stress Scale (DASS), respectively. One hundred individuals were recruited. Unadjusted analysis revealed that head involvement was associated with depression [odds ratio (OR) 8.509; 95% confidence interval (CI) 1.077-67.231] and anxiety (OR 6.46; 95% CI 1.401-29.858). Severe disease was associated with a poorer quality of life compared to mild disease (OR 3.750; 95% CI 1.330-10.577). Younger age was associated with an increased risk of depression [mean difference (MD) - 8.640; 95% CI - 16.390 to - 0.890], anxiety (MD - 11.553; 95% CI - 18.478 to- 4.628), stress (MD - 11.440; 95% CI - 19.252 to - 3.628) and severely impaired quality of life (MD - 12.338; 95% CI - 19.548 to - 5.127). Following adjustments for age and disease severity, anxiety, stress and depression remained associated with severely impaired quality of life.
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Affiliation(s)
- Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
| | - Yii Bonn Bong
- Institute of Research Management and Services, University of Malaya, Kuala Lumpur, Malaysia
| | - Leng Leng Tan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Shu Xian Lim
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Adrian Sze Wai Yong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chin Chwen Ch'ng
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rokiah Ismail
- School of Healthy Aging, Medical Aesthetics and Regenerative Medicine, UCSI University, Kuala Lumpur, Malaysia
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13
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Al Alawi M, Al Sinawi H, Al Qasabi AM, Al Mamari AM, Panchatcharam SM, Al-Adawi S. Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman. Int J Dermatol 2018; 57:284-290. [PMID: 29369339 DOI: 10.1111/ijd.13912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/08/2017] [Accepted: 12/18/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations. OBJECTIVES The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinical-demographic factors associated with depressive symptoms. METHODS A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs). RESULTS A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR = 9.41, 95% confidence interval [CI]: 2.27-39.05, P = 0.002; OR = 2.0, 95% CI: 1.2-3.21, P = 0.05; OR = 2.28, 95% CI: 1.09-4.76, P = 0.028; and OR = 2.78; 95% CI: 1.08-7.19, P = 0.035, respectively). CONCLUSION This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.
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Affiliation(s)
- Mohammed Al Alawi
- Oman Medical Specialty Board, Muscat, Oman.,Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hamed Al Sinawi
- Oman Medical Specialty Board, Muscat, Oman.,Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | | | - Samir Al-Adawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Aydin E, Atis G, Bolu A, Aydin C, Karabacak E, Dogan B, Ates MA. Identification of anger and self-esteem in psoriasis patients in a consultation-liaison psychiatry setting: a case control study. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1326740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ersin Aydin
- Department of Dermatology, Kasimpasa Military Hospital, Istanbul, Turkey
| | - Guldehan Atis
- Department of Dermatology, Dr. Siyami Ersek Thorax and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Bolu
- Department of Psychiatry, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Cigdem Aydin
- Department of Dermatology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ercan Karabacak
- Department of Dermatology, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Bilal Dogan
- Department of Dermatology, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Mehmet Alpay Ates
- Department of Psychiatry, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
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Simpson J, Wilson M, Ahmed A, Mizara A, Clarke A, McBride S. An exploratory study using framework analysis to investigate health‐seeking behaviour in patients with psoriasis. Br J Dermatol 2017; 177:742-750. [DOI: 10.1111/bjd.15307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/20/2022]
Affiliation(s)
- J.K. Simpson
- Department of Dermatology Royal Free London NHS Foundation Trust London U.K
| | - M. Wilson
- Department of Clinical Psychology Royal Free London NHS Foundation Trust London U.K
| | - A.A. Ahmed
- Department of Clinical Psychology Royal Free London NHS Foundation Trust London U.K
| | - A. Mizara
- Department of Dermatology Royal Free London NHS Foundation Trust London U.K
| | - A. Clarke
- Department of Clinical Psychology Royal Free London NHS Foundation Trust London U.K
| | - S.R. McBride
- Department of Dermatology Royal Free London NHS Foundation Trust London U.K
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Łakuta P, Przybyła-Basista H. Toward a better understanding of social anxiety and depression in psoriasis patients: The role of determinants, mediators, and moderators. J Psychosom Res 2017; 94:32-38. [PMID: 28183400 DOI: 10.1016/j.jpsychores.2017.01.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/28/2016] [Accepted: 01/09/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine how and under which conditions psoriasis is related to the psychological impairments, in particular, to social anxiety and depression, the current study tested the interplay of selected factors such as gender, age of onset of psoriasis, cognitive and affective elements of body image, experiences of stigmatization, and patients' subjective perceptions of severity of the disease. METHODS Adult psoriasis patients (N=193) completed the Appearance Schemas Inventory-Revised, the Stigmatization Scale, the Body Emotions Scale, the Beck Depression Inventory, and the Social Anxiety Questionnaire. The disease severity was defined based on the Body Surface Area (BSA) index. RESULTS The effect of psoriasis on social anxiety was moderated by age of onset: higher severity of the disease was associated with higher levels of social anxiety, but only for patients with pre-adult onset psoriasis. Hierarchical multiple regressions revealed that in patients with adult-onset (≥18years of age) the importance of appearance to one's sense of self-worth was the main contributor to social anxiety, while in patients with pre-adult onset, social anxiety was most strongly related to experiences of stigmatization. Moreover, the results indicated that negative body-related emotions mediated the relationship between severity of the disease and depression. Additionally, the relationship between severity of psoriasis and body image emotions was moderated by gender. CONCLUSIONS Findings significantly extend previous studies by confirming and highlighting the role of age of onset of psoriasis in psychological impairments, and provide more insight into factors that contribute to social anxiety in this group of patients.
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Affiliation(s)
- Patryk Łakuta
- SWPS University of Social Sciences and Humanities, Warsaw, Poland.
| | - Hanna Przybyła-Basista
- Department of Developmental Psychology and Family Research, Institute of Psychology, University of Silesia, Katowice, Poland
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Gooderham M, Gavino-Velasco J, Clifford C, MacPherson A, Krasnoshtein F, Papp K. A Review of Psoriasis, Therapies, and Suicide. J Cutan Med Surg 2016; 20:293-303. [DOI: 10.1177/1203475416648323] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many chronic medical disorders are associated with psychiatric morbidity. Yet the psychological burden of these disorders often goes unnoticed. In dermatology, psoriasis has a higher association with psychiatric illness, including depression and suicide risk, compared with many other conditions. Studies suggest that effective treatment of psoriasis results in the improvement of psychiatric morbidity, particularly depression and anxiety. New biologic treatments for psoriasis may offer help beyond clearing of the skin in these patients and may lead to a reduction of psychiatric morbidity. Although concerns have been raised regarding the potential link between interleukin-17R blockade in the treatment of psoriasis and suicide, current literature provides no evidence to support this association.
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Affiliation(s)
- Melinda Gooderham
- Skin Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | | | - Cole Clifford
- Skin Centre for Dermatology, Peterborough, ON, Canada
| | | | | | - Kim Papp
- K. Papp Clinical Research, Waterloo, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
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Determinants of acceptance of an illness in the case of patients suffering from psoriasis treated in the hospital and outpatient clinic settings. HEALTH PSYCHOLOGY REPORT 2015. [DOI: 10.5114/hpr.2015.53958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
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.<br />
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<b>Participants and procedure</b><br />
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).<br />
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<b>Results</b><br />
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.<br />
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<b>Conclusions</b><br />
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.
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Korman NJ, Zhao Y, Li Y, Liao M, Tran MH. Clinical symptoms and self-reported disease severity among patients with psoriasis - Implications for psoriasis management. J DERMATOL TREAT 2015; 26:514-9. [PMID: 25886083 DOI: 10.3109/09546634.2015.1034074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pain, itching, burning and irritation are common symptoms of psoriasis but have not been well characterized by overall psoriasis severity. METHODS Using 2012 syndicated psoriasis patient survey data, 1050 subjects were classified into mild (n = 610) and moderate-to-severe (n = 440) psoriasis severity groups based on self-reporting. Demographics, comorbid medical conditions and patient-reported key symptoms (i.e. flare-up frequency, psoriasis-related pain, itching, burning, hurting, irritation) were compared between groups. Multiple regressions were employed to examine the impact of overall psoriasis severity on each key symptom, controlling for demographics and comorbidities. RESULTS Mild patients were older; more than 20% in both groups had joint pain and depression. Over 35 and 68% of the moderate-to-severe patients reported severe pain between or during flare-ups, respectively, and over 79% reported frequent bothersome itching. Controlling for between-group differences, moderate-to-severe patients had worse pain, were more likely to have continual flare-ups (odds ratio = 3.0) and flare-ups more than once monthly (odds ratio = 3.0), and reported more bothersome symptoms than patients with mild disease (all p < 0.05). CONCLUSION The presence and level of particular symptoms increase with self-reported disease severity in patients with psoriasis. Careful investigation of symptoms in tandem with clinical observation is important for effective psoriasis management.
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Affiliation(s)
- Neil J Korman
- a Department of Dermatology , University Hospitals Case Medical Center , Cleveland , OH , USA
| | - Yang Zhao
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA , and
| | - Yunfeng Li
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA , and
| | - Minlei Liao
- c KMK Consulting Inc . , Florham Park , NJ , USA
| | - Mary Helen Tran
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA , and
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Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am 2014; 37:625-51. [PMID: 25455069 DOI: 10.1016/j.psc.2014.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article explores the way stress affects the skin, both at the molecular level, where the skin has an intricate connection to the neurocutaneous and immune systems, and at the clinical level. The concept of psychodermatology is reviewed with regard to the way skin reacts to stress, how stress is a trigger for several common skin diseases, and how neuropsychiatric disorders may have skin manifestations. The article is directed at making the dermatologist, the psychiatrist, the psychologist, and the primary physician familiar with the brain-skin mechanisms involved in stress and the resultant clinical expressions on the skin.
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Affiliation(s)
- Edgardo Rodriguez-Vallecillo
- Private Practice, 29 Washington Street, Suite 507, San Juan, PR 00907, USA; Dermatology, HIMA San Pablo Hospital, Sta. Cruz Street, Bayamon, PR 00961, USA.
| | - Michel A Woodbury-Fariña
- Department of Psychiatry, University of Puerto Rico School of Medicine, 307 Calle Eleonor Roosevelt, San Juan, PR 00918-2720, USA
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Fernández-Torres RM, Pita-Fernández S, Fonseca E. Quality of life and related factors in a cohort of plaque-type psoriasis patients in La Coruña, Spain. Int J Dermatol 2014; 53:e507-11. [DOI: 10.1111/ijd.12294] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Salvador Pita-Fernández
- Department of Clinical Epidemiology and Biostatistics; University Hospital of La Coruña; La Coruña Spain
| | - Eduardo Fonseca
- Department of Dermatology; University Hospital of La Coruña; La Coruña Spain
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Eskin M, Savk E, Uslu M, Küçükaydoğan N. Social problem-solving, perceived stress, negative life events, depression and life satisfaction in psoriasis. J Eur Acad Dermatol Venereol 2014; 28:1553-9. [PMID: 24404894 DOI: 10.1111/jdv.12355] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/26/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Psoriasis is a chronic dermatosis which may cause significant impairment of the patient's quality of life. OBJECTIVE The purpose of this study was to investigate the social problem-solving skills, perceived stress, negative life events, depression and life satisfaction in psoriasis patients. METHODS Data were gathered by means of questionnaires and clinical evaluations from 51 psoriatic patients and 51 matched healthy controls. RESULTS Average disease duration was 16.47 years and average Psoriasis Area and Severity Index score was 3.67. Compared with the controls, the patients displayed lower social problem-solving skills. They displayed higher negative problem orientation and impulsive-careless problem-solving style scores than the controls. Patients tended also to show more avoidant problem-solving style and lower life satisfaction than controls. There was no difference between psoriatic patients and controls in terms of depression, perceived stress and negative life events. Higher social problem-solving skills were associated with lower depression, perceived stress and fewer numbers of negative life events but higher level of life satisfaction. LIMITATIONS The patient group largely included mild and moderate psoriatic cases. CONCLUSION The findings of the study suggest that problem-solving training or therapy may be a suitable option for alleviating levels of psychological distress in patients suffering from psoriasis.
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Affiliation(s)
- M Eskin
- Adnan Menderes University, Faculty of Medicine, Department of Psychiatry, Aydin, Turkey
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Abstract
Introduction Psoriasis is a common, long-term skin condition associated with high levels of psychological distress and considerable life impact. The impact of psoriasis, beyond the skin, is often not recognised and under-treated. Methods This paper explores the relationship between psychological distress and psoriasis including reference to the ‘brain–skin access’. The life impact of psoriasis is discussed and pharmacological interventions which affect distress associated with psoriasis and psychological interventions are reviewed. Evidence from peer-reviewed journals and controlled trials inform the text. Results Psoriasis has a profound impact on mental health and well-being which is under-recognised by clinicians. The sympathetic adrenal medullary axis and hypothalamic pituitary adrenal axis are likely to be involved in the onset of psoriasis and there may also be an effect from inflammation in the skin on the central release of corticotrophin-releasing hormone. Psoriasis can be stigmatising and may affect all aspects of life including relationships, employment, social life and leisure activities. There is some evidence for psychological interventions being effective in the management of distress associated with psoriasis and psoriasis itself. Studies, however, have used disparate outcomes and methods and largely involve low numbers of patients. There is very limited access to psychological support for the patients with psoriasis despite evidence of high levels of psychological distress and considerable life impact. Conclusions Psoriasis is a long-term skin condition associated with high levels of distress and considerable life impact, both of which are under-recognised. Routine screening for distress with access to effective treatment is required. There is a need for high-quality studies to assess the effect of psychological intervention in patients with psoriasis both to inform guidance and facilitate the provision of effective psychological support services.
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Affiliation(s)
- Hee-Sun Moon
- Department of Dermatology, Royal Free NHS Foundation Trust, London, NW3 2QG, UK
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Ruiz-Carrascosa J. Ustekinumab y seguridad cardiovascular. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/s0001-7310(12)70006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rieder E, Tausk F. Psoriasis, a model of dermatologic psychosomatic disease: psychiatric implications and treatments. Int J Dermatol 2012; 51:12-26. [PMID: 22182372 DOI: 10.1111/j.1365-4632.2011.05071.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psoriasis is a common dermatologic disorder with psychiatric comorbidity that often goes undetected and untreated. Psoriasis has higher associations with psychiatric illness than do other dermatologic conditions. We conducted a comprehensive qualitative review of all published medical literature on psoriasis and psychiatric comorbidities since 2005. We found that psoriasis patients suffer psychiatric and psychosocial morbidity that is not commensurate with the extent of cutaneous lesions. Biologic therapies and nonpharmacologic psychosocial interventions show promise in treating comorbid psychiatric illness. The main limitations of this review are the low quality of published studies and the infrequent use of basic science endpoints in reporting treatment outcomes. The literature examining the psychiatric comorbidity of psoriasis is expanding but remains of variable quality. Stronger studies will be necessary to more accurately estimate comorbidities and help identify and comprehensively treat suffering patients.
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Affiliation(s)
- Evan Rieder
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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Abstract
Psoriasis is a chronic, relapsing, cutaneous condition with 1-2% prevalence in the general population. There are many factors involved in the induction and/or exacerbation of psoriasis of which stress is a well-known trigger factor in the appearance or exacerbation of psoriasis. Stress reaction in patients with psoriasis is probably mediated by the hypothalamic-pituitary-adrenal relationship with immunologic effects. Stress response involves increased levels of neuroendocrine hormones and autonomic neurotransmitters. Psychological stress or an abnormal response to stressors has been found to modify the evolution of skin disorders such as psoriasis. It can also have substantial psychological, and psychosocial impact on a patient's quality of life. Treatment regimens include stress-reduction strategies, such as biofeedback, meditation, yoga, and self-help approaches. This review focuses the relationship between psoriasis and stress, especially relating to psychosocial, psychological, and emotional stress aspects.
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Affiliation(s)
- Kabbur H Basavaraj
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS University, Mysore-570015, Karnataka, India.
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Mahajan R, Kanwar AJ, Kaur I. Assessing quality of life in patients with psoriasis and its improvement with treatment. J Eur Acad Dermatol Venereol 2011; 26:661-2. [PMID: 21672036 DOI: 10.1111/j.1468-3083.2011.04127.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Psychocutaneous Disorders: A Survey Study of Psychiatristsʼ Awareness and Treatment Patterns. South Med J 2010; 103:1199-203. [DOI: 10.1097/smj.0b013e3181fa73ef] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between mind and skin. It is divided into three categories according to the relationship between skin diseases and mental disorders. This article reviews different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/depression and those caused by psychiatric disorders are discussed. This review intends to present the relationship between the 'skin' and the 'mind' specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted. A multidisciplinary approach for treatment from both dermatologic and psychiatric viewpoints are suggested.
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Affiliation(s)
- K H Basavaraj
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS University, Mysore - 570 015, Karnataka, India
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Langley RG, Feldman SR, Han C, Schenkel B, Szapary P, Hsu MC, Ortonne JP, Gordon KB, Kimball AB. Ustekinumab significantly improves symptoms of anxiety, depression, and skin-related quality of life in patients with moderate-to-severe psoriasis: Results from a randomized, double-blind, placebo-controlled phase III trial. J Am Acad Dermatol 2010; 63:457-65. [PMID: 20462664 DOI: 10.1016/j.jaad.2009.09.014] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 09/01/2009] [Accepted: 09/15/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anxiety, depression, and impaired health-related quality of life (HRQoL) are common in patients with psoriasis. OBJECTIVE We sought to analyze the effect of ustekinumab on these conditions in patients with moderate-to-severe psoriasis. METHODS Patients with moderate-to-severe psoriasis (n = 1230) were randomized 1:1:1 to receive 45 mg of ustekinumab, 90 mg of ustekinumab, or placebo. The Hospital Anxiety and Depression Scale was used to measure anxiety and depression, and the Dermatology Life Quality Index to measure HRQoL. RESULTS At baseline, 40.3% and 26.7% of patients reported symptoms of anxiety and depression, respectively, and 54.6% reported Dermatology Life Quality Index scores greater than 10, indicating a very high impact of disease on HRQoL. Greater improvements at week 12 in mean Hospital Anxiety and Depression Scale-Anxiety (13.9%), Hospital Anxiety and Depression Scale-Depression (29.3%), and Dermatology Life Quality Index (76.2%) scores were reported in ustekinumab groups compared with placebo (P < .001 each). LIMITATIONS Results for these measures are reported only through 24 weeks. CONCLUSION Patients receiving ustekinumab reported significant improvements in symptoms of anxiety, depression, and HRQoL.
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Lert CT, Fai CM. A systematic review of the effectiveness of therapeutic interventions on quality of life (QoL) for adult vitiligo patients. ACTA ACUST UNITED AC 2010. [DOI: 10.11124/jbisrir-2010-159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lert CT, Fai CM. A systematic review of the effectiveness of therapeutic interventions on quality of life (QoL) for adult vitiligo patients. JBI LIBRARY OF SYSTEMATIC REVIEWS 2010; 8:1169-1201. [PMID: 27820500 DOI: 10.11124/01938924-201008290-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Vitiligo is the most common pigmentation disorder. It is an acquired, progressive disorder, presenting with white macules that can appear anywhere on the skin. Presently, there is no cure for vitiligo. Although there are therapies targeted at improving its appearance, their effectiveness is limited. Without satisfactory solution to vitiligo, patients are permanently disfigured for life. Quality of life of vitiligo patients has been commonly found to be moderately impaired. Patients are chronically embarrassed and depressed. Stigmatisation is also common and cause marginalization. Hence, while vitiligo is not "life-threatening", it can be "life-ruining". Because current treatments are unsatisfactory in repigmenting the skin, the question of continuing treatment must also consider the benefits to quality of life, and that is the purpose of this review. OBJECTIVE The overall objective of this systematic review was to examine the effectiveness of therapeutic interventions, in terms of quality of life for adult patients with vitiligo. INCLUSION CRITERIA Types of studies - The review considered quantitative papers, including randomised controlled trials and quasi-experimental studies.Types of participants - Adult patients who have vitiligo from 18 to 75 years-old.Types of interventions - This review considered studies of current therapeutic interventions for vitiligo, including oral, topical, combination, camouflage, cognitive-behavioural therapy and grafting.Types of measured outcomes - Quality of life outcomes as measured by validated tools. SEARCH STRATEGY The search aimed to find published studies and papers, limited to English language reports. A three-step search strategy was utilised: An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms were then undertaken. Search strategies were developed using terms that were specific to the databases. Thirdly, the reference lists of all identified papers were searched for additional studies. The databases searched include: PubMed, CINAHL, Scopus, JSTOR, ScienceDirect,PsycARTICLES (Ovid) and PsycINFO (Ovid) DATA COLLECTION: Two reviewers critically appraised the methodological quality of research studies using a standardised critical appraisal tool from the Joanna-Briggs Institute. DATA ANALYSIS Data was extracted from nine papers for this review, however as the studies were heterogeneous in population, interventions and methodologies, it was not possible to conduct a meta-analysis to establish superiority of interventions in terms of improving quality of life. Hence, a narrative summary was presented to collate the results of the interventions where there were similar. RESULTS All treatments were found to improve quality of life for vitiligo patients. Disease-altering interventions that were effective in repigmentation arrest of disease progression were also effective in improving quality of life. Lifestyle-altering interventions were found to be selectively effective for patients with more severe quality of life impairment and Subscale analysis showed particular effectiveness of interventions in improving the emotional dimension of quality of life. CONCLUSION Current interventions for vitiligo are effective in bettering the quality of life either by improving physical appearance of the patient or by addressing the psychological distress directly. Less effectiveness was achieved for the functional and social dimensions, which are more dependent on social and cultural norms. This suggests that current interventions alone are inadequate to address the holistic quality of life challenges associated with vitiligo. IMPLICATIONS FOR PRACTICE IMPLICATIONS FOR RESEARCH.
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Affiliation(s)
- Chua Tse Lert
- 1. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore National University Hospital (NUH) Centre for Evidence Based Nursing: A collaborating centre of the Joanna Briggs Institute
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Tabolli S, Calza A, Di Pietro C, Sampogna F, Abeni D. Quality of life of psoriasis patients before and after balneo -- or balneophototherapy. Yonsei Med J 2009; 50:215-21. [PMID: 19430554 PMCID: PMC2678696 DOI: 10.3349/ymj.2009.50.2.215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 03/25/2008] [Accepted: 03/25/2008] [Indexed: 12/04/2022] Open
Abstract
PURPOSE An 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 METHODS TWO 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. RESULTS SAPASI 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. CONCLUSION Comano 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.
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Affiliation(s)
- Stefano Tabolli
- Health Services Research Unit, Istituto Dermopatico dell'Immacolata (IDI-IRCCS), Rome, Italy.
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Waernulf L, Moberg C, Henriksson EW, Evengard B, Nyberg F. Patients' views on care and treatment after phototherapy for psoriasis and atopic eczema including a gender perspective. J DERMATOL TREAT 2009; 19:233-40. [PMID: 18608725 DOI: 10.1080/09546630801955127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Psoriasis and atopic eczema are reportedly as common among women as among men and are not known to differ in severity between sexes. Research has shown that men get more treatment with ultraviolet (UV) light for longer periods than women. This fact, together with ongoing efforts to improve patient satisfaction with care and treatment at our department, prompted us to gather information from our patients. OBJECTIVE The aim of this study was to explore patients' views of dermatological care and treatment methods. METHOD A questionnaire-based survey was carried out, complemented with qualitative interviews. RESULTS The main findings fall under three areas of clinical relevance: information to patients must be individually designed with a gender perspective; men and women have different attitudes towards greasing which must be kept in mind in clinical practice; and women often appear to be under-prescribed UV treatment. CONCLUSION The information from our study can form a basis for new therapeutic strategies, taking a gender perspective into account.
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Affiliation(s)
- Lena Waernulf
- Department of Clinical Sciences, Unit of Dermatology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
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Magin P, Adams J, Heading G, Pond D, Smith W. The psychological sequelae of psoriasis: Results of a qualitative study. PSYCHOL HEALTH MED 2009; 14:150-61. [PMID: 19235074 DOI: 10.1080/13548500802512294] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sassi F, Cazzaniga S, Tessari G, Chatenoud L, Reseghetti A, Marchesi L, Girolomoni G, Naldi L. Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol 2008; 159:1186-91. [PMID: 18717675 DOI: 10.1111/j.1365-2133.2008.08793.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vitiligo is a pigmentary disorder which may have disfiguring consequences. Its treatment remains a challenge. OBJECTIVES We designed a parallel-group randomized controlled trial to compare the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in patients with vitiligo unresponsive to previous treatment with topical steroids or narrow-band ultraviolet (UV) B phototherapy. METHODS Consecutive patients aged 18-75 years with nonsegmental vitiligo localized on the face and/or neck lacking response to previous conventional treatment were eligible. In total, 84 patients (44 women and 40 men, mean age 44 years) were randomized to 308-nm excimer laser phototherapy twice weekly alone or in combination with topical hydrocortisone 17-butyrate cream twice daily for three periods of 3 weeks followed by a 1-week steroid-free interval. The primary outcome was a reduction of at least 75% of the overall lesional areas as judged by automatic image analysis on reflected UV photographs, conducted blind to treatment assignment, at 12 weeks compared with baseline. Secondary outcomes were clearance, and improvements on Physician's Global Assessment (PGA) and Skindex-29 scores. RESULTS A total of 76 (90%) patients completed the study. In an intention-to-treat analysis, seven [16.6%; 95% confidence interval (CI) 5.3-27.8%] patients in the excimer monotherapy arm and 18 (42.8%; 95% CI 27.8-57.8%) in the combination arm showed > or = 75% reduction of vitiligo lesions at 12 weeks (chi(2) test 6.89, P = 0.0087). Clearance was observed in two (4.7%; 95% CI 1.6-11.2%) and nine (21.4%; 95% CI 9.0-33.8%) patients, respectively (Fisher's exact test P = 0.04). A significant difference also emerged for PGA scores, while no difference was documented for Skindex-29. CONCLUSIONS Recalcitrant vitiligo of the face and neck may benefit from the combination of excimer laser phototherapy with topical hydrocortisone 17-butyrate cream.
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Affiliation(s)
- F Sassi
- Centro Studi GISED, Ospedali, Riuniti, 24100 Bergamo, Italy
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Bessis D. Psoriasis sévère, au-delà de la peau, quel est le risque à ne pas traiter ? Ann Dermatol Venereol 2008; 135 Suppl 5:S285-9. [DOI: 10.1016/s0151-9638(08)73672-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tabolli S, Mozzetta A, Antinone V, Alfani S, Cianchini G, Abeni D. The health impact of pemphigus vulgaris and pemphigus foliaceus assessed using the Medical Outcomes Study 36-item short form health survey questionnaire. Br J Dermatol 2008; 158:1029-34. [PMID: 18294312 DOI: 10.1111/j.1365-2133.2008.08481.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pemphigus vulgaris and pemphigus foliaceus are rare, potentially life-threatening, autoimmune disorders characterized by antibodies to epidermal adhesion molecules. Clinical characteristics are painful chronic erosions of mucous membranes and of the skin. There are only few published studies on the impact of the disease on the health status (HS) of patients with these conditions. OBJECTIVES To assess the impact of disease on the HS of patients with pemphigus. METHODS Fifty-eight patients enrolled at the Bullous Skin Diseases Unit of IDI-IRCCS in the period January-June 2006 were assessed for their HS using the Medical Outcomes Study 36-item short form health survey (SF-36) questionnaire and for anxiety and depression using the Institute for Personality and Ability Testing questionnaires. RESULTS A compromised HS on both the physical and the psychosocial scales was observed, similar to other chronic dermatological diseases such as psoriasis. Patients with anxiety had severe disease as measured by the Physician's Global Assessment and the degree of mucocutaneous involvement, as well as those with a more recent disease onset. A better HS was observed in patients whose clinical condition was rated as nonsevere, and also in patients with pemphigus foliaceus. In pemphigus vulgaris, antidesmoglein 3 antibody levels directly correlated with clinical severity and with lower SF-36 scores. CONCLUSIONS HS evaluated with the SF-36 can be a very useful additional outcome criterion in clinical studies with pemphigus. The management of the disease must take into account its impact on various aspects of life of the patient.
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Affiliation(s)
- S Tabolli
- Health Services Research Unit. IDI-IRCCS, Via Monti di Creta 104, 00167 Rome, Italy.
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Affiliation(s)
- Judith Hong
- Department of Dermatology, University of California, San Francisco, California 94118-2616, USA.
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