Quality of life impairment and psychological distress in elderly patients with psoriasis

Evaluation of the sexual sphere in patients with psoriatic arthritis

INTRODUCTION

Psoriatic arthritis (PsA) is a chronic inflammatory disorder that primarily affects the joints and entheses. In addition, it is associated with depressive syndrome (DS), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), obesity and psoriasis (Pso). There are few studies aimed to analyze the association of the involvement of the musculoskeletal system with sexual function (SF).

METHODS

A cross-sectional observational study was proposed in patients diagnosed with PsA, to whom self-administered validated questionnaires were applied to determine alterations in SF: MGH-SFQ and CSFQ-14, which assess the 4 domains of sexual function; Qualisex and DLQI designed for joint and dermatological pathology respectively, which explore sexual aspects. The objective was to describe the existence of altered sexual function in patients with PsA; analyze the association between sociodemographic characteristics, comorbidities (Pso, DS, cardiovascular risk factors) and the treatments of patients on SF; and describe differences of SF according to gender.

RESULTS

72 patients were evaluated. It was observed that the variables of patients with PsA that were associated with lower scores in SF were gender and age in the CSFQ-14 and MGH-SFQ; annual incomes, treatment with NSAIDs, DL and depression were associated with worse results in some domains of the sexual sphere.

CONCLUSIONS

Patients with PsA had impaired SF, especially women, elder patiens, those with low annual incomes, DL and emotional disorders. Anti-inflammatory treatments were associated with better SF. Globally, the chronic disease and the psychological burden behaved as factors associated with sexual dysfunction.

Treating psoriasis in the elderly: biologics and small molecules

INTRODUCTION

Psoriasis prevalence in the elderly is growing. It is estimated that 15% of elderly psoriasis patients suffer from moderate-to-severe disease, thus requiring systemic treatments. However, conventional systemic agents' use is limited due to contraindications and drug-interactions. Conversely, biologics and small molecules seem to be a valuable option, although the geriatric psoriasis population is frequently excluded from trials and shared guidelines are lacking.

AREAS COVERED

Relevant English literature (trials, real-life studies, case series, and reviews) regarding biologics and/or small molecules in the elderly were searched for up to January 17, 2022.

EXPERT OPINION

Treatment of moderate-to-severe psoriasis in the elderly may be challenging due to multiple comorbidities, polypharmacy, and increased risk of infections and cancers. However, new targeted therapies offer the possibility to perform a tailored-tail management, considering comorbidities, drug-interactions, and frailties which characterize this class of patients. Several real-world data support biologics and small molecules' efficacy and safety in the elderly with mainly no significant difference as compared to young adults. Elderly psoriasis patients' expectations are as high as those of their younger counterparts. Hence, they deserve the best therapeutic options according to their peculiarities for a long-term psoriasis remission and an improved quality of life.

Medicinal Treatment of Elderly Psoriasis Patients before and after Entering a Nursing Home

Psoriasis (PS) is a chronic inflammatory skin disease, and it increasingly appears also in the elderly population. There is a rising interest in drug therapy for PS, especially for people receiving care in nursing homes (NH). Which PS-related drugs are prescribed in the time before nursing home admission (NHA), and to what extent does the supply of drugs change after NHA? Which specialties prescribe PS-related drugs? Statutory health insurance data were examined for people with PS, aged ≥ 65 years, who were newly admitted to a NH in the period 2011-2014 and observed for one year before and after NHA. Changes in prescription prevalence (pre-post comparison) were examined for significant differences. Prescriptions of PS-relevant drugs were measured by defined daily dose and stratified according to the prescribing specialist group. The analysis included 718 insured persons with PS (76.2% female, mean age 83.3 years). Systemic therapeutics played a minor role (pre: 2.6% vs. post: 2.1%) in drug therapy. Topical steroids had a high share of about 40% in the pre-post comparison. Overall, the proportion of people with PS who received treatment remained at a comparable level before and after NHA. A structured assessment of the skin is crucial, specifically in people with cognitive impairment.

Depressive, anxiety, stress, and insomnia symptoms in patients with psoriasis: a cross-sectional study

Introduction

Assessment of psychological well-being in psoriasis patients is recommended. However, studies evaluating depressive, anxiety, stress, and insomnia symptoms in Arabic patients with psoriasis are lacking.

Aim

To quantify levels of psoriasis-related depressive, anxiety, stress, and insomnia symptoms in Arabic patients with psoriasis.

Material and methods

A cross-sectional survey on patients’ demographics, disease characteristics, and psychological measures using the Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, Depression Anxiety Stress Scale-21 (7-item stress subscale), and Insomnia Severity Index. The prevalence and scores of depressive, anxiety, stress, and insomnia symptoms were calculated. Multivariate linear regression models were developed to assess patients’ demographics and disease characteristics affecting the psychological measures.

Results

The analysis included 223 patients. The patients reported mild levels of depressive, anxiety, and insomnia symptoms (median (interquartile range (IQR)) scores: 9 (6–14), 6 (4–11), and 12 (4–18), respectively) and a moderate level of stress symptoms (median (IQR) score: 10 (5–14)). The prevalence of depressive, anxiety, stress, and insomnia symptoms were 47.1%, 32.7%, 59.6%, and 57%, respectively. Multivariate linear regression analyses revealed that for each unit increase in the impact of psoriasis on daily life, there were 5.7 (95% confidence intervals (CI): 3.7–7.8), 3.8 (95% CI: 1.8–5.7), 5.3 (95% CI: 3.1–7.4), and 6.5 (95% CI: 3.7–9.4) units increase in depression, anxiety, and stress, and insomnia scores, respectively.

Conclusions

The prevalence of depressive, anxiety, stress, and insomnia symptoms in Arabic patients with psoriasis was high. Clinical interventions, screening for psychiatric comorbidities, and consideration of psychotherapy should be implemented in this patient group.

Treatment of Medicare Patients with Moderate-to-Severe Psoriasis who Cannot Afford Biologics or Apremilast

Elderly patients are a group with a high frequency of psoriasis. Their disease burden has negative impacts on their quality of life. While there is a clear need to treat these patients, there are challenges in doing so. This work seeks to define the challenges that exist in treating elderly Medicare patients, as well as to provide treatment suggestions for providers to follow if they encounter one or more of these challenges. Providers face the following challenges when creating treatment plants for elderly patients with psoriasis: difficulty in obtaining drug coverage through Medicare, increased medical comorbidities, and polypharmacy. Providers aim for regimens that are affordable, safe, and efficacious, but it is not always clear how to achieve this combination, especially in elderly Medicare patients. This work is relevant in that it aims to explain the logistical roadblocks posed by Medicare coverage and provide solutions for commonly encountered issues in the treatment of a disabling and common disease in a high-risk population. Specifically, alternative treatment options to biologics and small-molecule inhibitors are discussed and include topical therapies, phototherapy, methotrexate, acitretin, and cyclosporine and for psoriatic arthritis include corticosteroids and leflunomide. The specific risks and benefits of these therapies in the elderly population are provided, allowing providers to make patient-specific decisions about optimal regimens.

The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials

Background

Previous observational studies have shown comorbidity between psoriasis and psychological disorders. However, the evidence of the efficacy of psychological interventions, including cognitive behavioral therapy (CBT) and other treatments, on psoriasis is still debated.

Objectives

The aim of this study was to systematically review the psychological interventions used in the treatment of psoriasis and to meta-analyze the efficacy of psychological interventions on psoriasis with respect to area and severity reduction.

Materials and methods

A systematic review and meta-analysis were conducted. PubMed, Web of Science, EMbase, and major Chinese academic journal databases were searched for articles published before January 2018. Studies of randomized controlled trials (RCTs) that applied psychological interventions in the treatment of psoriasis and used area and severity as the outcome measures were meta-analyzed. The pooled mean difference between groups was estimated using either fixed-effects models or random-effects models in the presence of heterogeneity. Subgroup analysis was performed by method of intervention and severity of psoriasis.

Results

Out of the 4,152 potentially relevant studies, 8 RCTs were included. The pooled mean difference was −1.36 (95% CI: −2.52 to −0.19; P=0.02). The pooled estimate was −1.80 (95% CI: −2.57 to −1.03; P<0.001) for CBT intervention and was −0.70 (95% CI: −2.39 to 0.99; P=0.42) for non-CBT intervention. The pooled estimates for mild and moderate-to-severe psoriasis were −1.95 (95% CI: −3.91 to 0.00; P=0.05) and −0.61 (95% CI: −1.61 to 0.38; P=0.23), respectively.

Conclusion

CBT is effective in the treatment of psoriasis in terms of area and severity reduction. Systemic treatment does not further enhance the efficacy of CBT. The effect of the psychological intervention is stronger in patients with moderate-to-severe psoriasis.

Preliminary development of a questionnaire assessing the impact of psoriasis and psoriatic arthritis on patient's perception of sexuality

Psoriasis and psoriatic arthritis impact sexuality and intimate relationships in both men and women, and can be associated with sexual dysfunctions.The aim of this study was to develop and validate a specific questionnaire assessing the impact of psoriasis and psoriatic arthritis on patients' sexuality. Two focus groups of patients, concerned by sexuality, were conducted in February 2015. Based on the verbatim transcripts, a content analysis was performed by a psychologist trained in qualitative procedures.After analysis of the verbatim reports by the research group, a preliminary questionnaire comprising 22 questions was drawn up. The areas covered by the questions concerned: the quality of daily life, tolerance of the cutaneous state by the patient, tiredness, mobility and flexibility of the joints, outside activities involving movement of all or part of the body. In the following step the questions were then submitted to a panel of experts for selection using a Delphi method. The experts were questioned about item relevance and content. After expert consensus had been reached, the instructions to participants completing the questionnaire, the wording of items, and the possible answers were finalized.The final questionnaire (comprising 14 questions) is entitled "Questionnaire of sexual quality of life perceived by patients with cutaneous and/or articular psoriasis" (short denomination: Qualipsosex). The quantitative step has not yet been conducted. This step will aim to evaluate the metrologic qualities (reliability, validity, and responsiveness) of the questionnaire and will need to be validated according to the consensus-based standards for the selection of health measurement instrument checklist.

The level of emotion control, anxiety, and self-efficacy in the elderly in Bialystok, Poland

PURPOSE

The aim of the study was to assess the level of emotion control, anxiety, and self-efficacy in the inhabitants of Bialystok (Poland) aged above 60.

PATIENTS AND METHODS

The study included 300 people above the age of 60, inhabitants of Bialystok and its neighborhoods: 100 residents of public nursing home, 100 participants of the University of the Third Age in Bialystok, and 100 students of the University of Healthy Senior. The three standardized psychometric scales were used in the study: Courtauld Emotional Control Scale (CECS), State-Trait Anxiety Inventory (STAI), and General Self-Efficacy Scale (GSES).

RESULTS

The median of the overall score of CECS equaled 54 points, which is considered average in terms of negative emotions acceptance. The mean score of perceiving anxiety as the condition of STAI (X1) was 48 points, while anxiety as a trait of STAI (X2) was 49 points. The overall score for GSES proved that respondents had a subjective feeling of self-efficacy at the level of 29 points out of 40 points possible, which means that their self-efficacy was rather at the high level in their self-assessment. In women, a negative correlation was revealed between the sense of self-efficacy and age (r=-0.320, P<0.001). Analyzing the study group affiliation of respondents, a negative correlation was reported between the sense of self-efficacy and age among the elderly residents of public nursing home (r=-0.408, P<0.001). Taking into consideration the study group affiliation of respondents, a positive correlation between anger control (CECS) and the sense of anxiety as a trait of STAI (X2) was found among participants of the University of Healthy Senior (r=0.307, P=0.002).

CONCLUSION

The social and demographic features (gender, group affiliation, age) analyzed in the study were found to be correlated significantly with the control of negative emotions, the level of anxiety, and self-efficacy. The study group affiliation was a key variable conditioning the relations between the analyzed features. The elderly residents of public nursing home belonged to the group distinguishing negatively compared to other two study groups. The study respondents were characterized by the relatively high perception of anxiety, which may be as a result of the health and social problem present in this age group. In order to improve the quality of life, the study population should reduce level of perceived anxiety and increase the control of negative emotions and self-efficacy by social integration of seniors. The study scores in the scale of CECS, STAI, and GSES do not deviate from the world norms obtained by other researchers in the rest of the world.

Quality of life in adults with facial port-wine stains

BACKGROUND

Facial port-wine stains (PWS) are considered by some an aesthetic skin problem, yet impact on quality of life (QoL) has not been objectively documented.

OBJECTIVE

We sought to (1) characterize the effect of PWS on QoL in adults, (2) to identify the clinical and demographic factors that affect QoL, and (3) to compare our results with QoL studies in other skin conditions.

METHODS

In total, 244 adults with facial PWS completed an online QoL survey, which included the Skindex-29 instrument.

RESULTS

QoL in adults with facial PWS was diminished, especially from an emotional perspective. Variables associated with reduced QoL in all Skindex-29 subdomains included comorbid depression, limited facial mobility, and presence of other skin conditions. Persons with hypertrophy had more emotional and symptomatic impairment. The composite dermatologic-specific QoL scores were similar to those of cutaneous T-cell lymphoma, rosacea, alopecia, and vitiligo.

LIMITATIONS

Selection bias was a potential limitation, as participants were primarily recruited from patient support groups.

CONCLUSION

Our analysis demonstrates that the presence of a facial PWS has a significant negative impact on QoL. Dermatologists caring for patients with PWS should inquire about QoL, provide appropriate support and resources, and consider QoL when discussing treatment options and obtaining authorization for these procedures.

Early- and late-onset psoriasis: a cross-sectional clinical and immunocytochemical investigation

BACKGROUND

There is accumulating evidence that early-onset psoriasis (EOP; presenting at or before 40 years of age) and late-onset psoriasis (LOP; presenting after 40 years of age) are different diseases.

OBJECTIVES

We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP.

METHODS

We assessed immunocytochemistry in involved (PP) skin and uninvolved skin (n = 31) and demographics, psoriasis phenotype and psychological parameters (n = 340) in a cross-sectional study.

RESULTS

Immunocytochemistry revealed (17 EOP, 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP compared with LOP (P = 0·03), with a higher epidermal CD4⁺ : CD8⁺ ratio in LOP (1·3) compared with EOP (0·5) (P = 0·002). In 340 patients with psoriasis (278 EOP, 62 LOP), we found an association with a positive first or second degree family history of psoriasis [62·0% vs. 35·6%, adjusted odds ratio (OR) 8·32, 95% confidence interval (CI) 1·90-36·52] and a higher likelihood of having parents with EOP (adjusted OR 10·34, 95% CI 1·32-81·83) in the EOP group. Patients with EOP were more likely to have received biological therapy (13·3% EOP vs. 3·5% LOP, P = 0·042), while patients with LOP had a higher likelihood of having type 2 diabetes (adjusted OR 3·43, 95% CI 1·004-11·691) and autoimmune thyroiditis (adjusted OR 5·05, 95% CI 1·62-15·7). Patients with LOP also had greater anxiety than patients with EOP (mean Hospital Anxiety and Depression Scale-A score LOP 8 ± 5, EOP 5 ± 5; P = 0·006).

CONCLUSIONS

Our findings provide further evidence for the difference between EOP and LOP.

Health-related quality of life in patients with psoriasis

BACKGROUND

Psoriasis is a chronic skin disease that has a significant impact on patients' lives.

OBJECTIVE

The purpose of the study was to assess factors that might influence the health-related quality of life (HRQoL) of patients with psoriasis.

METHODS

We conducted a cross-sectional study of 110 outpatients with psoriasis. To assess the HRQoL, The Short Form 36 Health Survey (SF-36) and Skindex-29 were administered. Stressful life events during the last 12 months were assessed with Paykel's Interview for Recent Life Events.

RESULTS

HRQoL was significantly more impaired in older patients, those with age at onset of 40 years or more, who had a positive family history and who experienced stressful life events in the 12 months preceding the interview. Sex and clinical severity were not significantly related to patients' HRQoL.

CONCLUSION

Psoriasis patients have poorer HRQoL than the general population. This study supports the decision to use both generic and skin-specific instruments to assess the impact of psoriasis on HRQoL.

Quality of life in cutaneous lupus erythematosus

BACKGROUND

Little is known about quality of life in patients with cutaneous lupus erythematosus.

OBJECTIVE

We sought to determine how cutaneous lupus affects quality of life and which independent variables are associated with poor quality of life.

METHODS

A total of 157 patients with cutaneous lupus completed surveys related to quality of life, including the Skindex-29 and the Short Form-36.

RESULTS

Quality of life in cutaneous lupus is severely impaired, particularly with respect to emotional well-being. Patients with cutaneous lupus have worse quality of life than those with other common dermatologic conditions, such as acne, nonmelanoma skin cancer, and alopecia. With respect to mental health status, patients with cutaneous lupus have similar or worse scores than patients with hypertension, type 2 diabetes mellitus, recent myocardial infarction, and congestive heart failure. Factors related to poor quality of life include female gender, generalized disease, severe disease, distribution of lesions, and younger age.

LIMITATIONS

The study was done at a single referral-only center.

CONCLUSION

Patients with cutaneous lupus have very impaired quality of life, particularly from an emotional perspective.

Evolution of and risk factors for psychological distress in patients with psoriasis: the PSYCHAE study

Psychological distress (PD) is common in patients with psoriasis but little is known about its evolution. The aim of this study is to assess the evolution of PD in psoriasis. For this purpose, 1,505 psoriatic patients, who had been previously enrolled in the PSYCHAE study, an observational multicenter Italian study, were re-evaluated after 6 and 12 months. Minor and major PD were assessed using the General Health Questionnaire (GHQ) and Brief Symptoms Inventory (BSI) questionnaires and coping using Brief COPE questionnaire. Minor PD was present in 46 percent of patients but halved during the study. Female gender, surface area, topical steroids, methotrexate, self-distraction, venting and behavioral disengagement were risk factors for minor PD; cyclosporine and humor were protective. Major PD was present in 11 percent of patients and remained stable. Female gender, venting, religion, behavioral disengagement and emotional support were risk factors for major PD; instrumental support was protective. In conclusion, the results obtained suggest that major PD remained stable after 12 months and that coping was a predictor of its evolution.

Perception of disease and doctor-patient relationship experienced by patients with psoriasis: a questionnaire-based study

Many studies have addressed the impact of psoriasis on quality of life, but few studies have investigated patient perception of the disease or the patient-physician relationship. As with most chronic diseases, improvement in the patient-physician relationship may be important in the proper management of patients with psoriasis. To assess how psoriasis and its treatments are subjectively experienced by patients as well as patient expectations with regard to the patient-physician relationship. A discussion agenda for 'focus group meetings' was organized by a group of sociologists, psychologists, educators, researchers, and clinicians active in the field of psychodermatology. Four meetings were held in Northern and Central Italy and participants included one moderator and either eight dermatologists or eight patients. Discussions were based on a predefined agenda and included: (i) the psychological representation of psoriasis; (ii) the hetero- and self-perception of the patient; (iii) the patient-physician relationship; and (iv) the development of an educational intervention for dermatologists in order to improve the patient-physician relationship. A questionnaire, based on the information gathered at the focus groups, was administered to 323 patients with moderate to severe chronic plaque psoriasis from 17 dermatology clinics throughout Italy. Three hundred patients completed the questionnaire. Psoriasis elicited anger, annoyance at the inconvenience of the disease, and irritation in approximately 50% of the patients, whilst 38% of patients were unable to describe their emotional state. Aspects of life that were limited by psoriasis included clothing (57%), social interactions (43%), and personal hygiene (31%). The disease was often seen by patients as incomprehensible, incurable, and uncontrollable. More than half of the patients stressed their need to be listened to by the treating physician, and their wish that the physician should use simple language and should improve their psychological skills and interpersonal communication techniques. Dermatologists need to convey to patients with psoriasis the feeling of 'understanding the disease,' of hope about its curability, and the 'perception of control.' These elements should be taken into account when treating patients and whenever educational interventions are planned.

Control of negative emotions and its implication for illness perception among psoriasis and vitiligo patients

BACKGROUND

The purpose of the study was to determine the intensity of control over negative emotions of anger, depressed mood, and anxiety in certain skin diseases such as psoriasis and vitiligo, and to define the predictors of this emotional control in terms of the illness perception in the following context: duration of illness, age at onset, subjective knowledge of the causes of illness, subjective sense of control over the disease.

METHODS

The study included 60 patients with psoriasis (n = 30) and vitiligo (n = 30) as well as healthy persons (n = 60) matched to the experimental group in terms of gender, age, and level of education. Control of negative emotions was examined by means of Watson and Greer's Courtauld Emotional Control Scale (Polish adaptation by Juczynski) and the illness perception by means of Kossakowska's Chronic Patients Questionnaire.

RESULTS

The research concludes that psoriasis patients control negative emotions more intensively than healthy people. Vitiligo patients on the other hand do not differ in the control of negative emotions compared with healthy subjects. There are no significant predictors of negative emotional control in vitiligo. In psoriasis gender and age are the main contributors to negative emotional control and anger control is predicted by the age at onset as well.

CONCLUSION

The specificity of the skin disease affects maladaptive negative emotional control and the suggestion is to use psychological treatment in hospitalised psoriasis in particular.

Willingness-to-pay stated preferences for 8 health-related quality-of-life domains in psoriasis: a pilot study

BACKGROUND

Psoriasis is a chronic skin condition that has a major impact on health-related quality of life (QOL). We evaluated health-related QOL via willingness to pay and a ranking task for 8 domains of health relevant to psoriasis: intimacy, physical comfort, self-care, ability to work or volunteer, ability to concentrate, emotional health, social comfort, and ability to sleep.

OBJECTIVE

The goals of the study were to pilot test a new method to measure QOL impact in psoriasis and identify the areas of life most affected by psoriasis.

METHODS

Forty participants with a history of psoriasis were interviewed in a face-to-face format. First, participants were asked to rank the 8 domains of health we were investigating. Second, patients were asked how much money they would be willing to pay for a hypothetical cure for each domain of health. Responses in US dollars were interpreted as strength of preference rather than absolute monetary values.

RESULTS

About half of the patients in the sample (48%) were female, 60% had a college degree or further education, and 38% had an income level over $45,000/y. Physical comfort, social comfort, and emotional health were highly ranked by more than 75% of respondents. Ability to concentrate was least likely to be affected by psoriasis with just a quarter (25.7%) of respondents ranking this domain as important. The median amount patients were willing to pay for a hypothetical cure of psoriasis specific to a particular domain was highest for physical comfort ($2000, 25th quartile = $500, 75th quartile = $5500) and emotional health ($2000, 25th quartile = $250, 75th quartile = $5000), and lowest for ability to sleep ($625, 25th quartile = $50, 75th quartile = $5000).

LIMITATIONS

The sample size is modest for this pilot study. Willingness to pay as a method of eliciting stated preferences for qualitative aspects of health may be influenced by individual perception of money.

CONCLUSIONS

This study successfully pilot tested a willingness-to-pay method and a ranking task to measure the relative severity of 8 domains of health-related QOL and found that physical comfort, social comfort, and emotional health were the domains of health most affected by psoriasis.

The reduced Impact of Psoriasis Questionnaire has good psychometric properties in Italian patients

BACKGROUND

A recent refinement study suggested that a Rasch reduced version of the Impact of Psoriasis Questionnaire (IPSO) of 11 items most adequately assessed the psychosocial impact of US psoriasis patients.

OBJECTIVE

To test whether the IPSO would also behave well in a different population that varies culturally, demographically, and in disease severity.

METHODS

The psychometric properties of the IPSO, using classical test and item response theory (Rasch analysis), were assessed in 805 Italian psoriasis patients.

RESULTS

Patients with more severe psoriasis reported significantly higher impact on their HRQOL (p < 0.001) and the IPSO correlated well with the Skindex-29 (r = 0.74) confirming its validity. The response distribution was adequate for all items, except item 9. The Cronbach's alphas were excellent and the high item-rest correlations confirmed its homogeneity. Principal component analysis demonstrated one dominant factor with an eigenvalue of 4.47 (items loading >0.40). Overall, the 11 IPSO items fitted the Rasch model (p = 0.07) and all items demonstrated a logical threshold order. Of the 11 items, 2 items showed significant individual misfit and only 1 item demonstrated significant differential item functioning for age but none for gender or global severity score.

CONCLUSION

The 11-item IPSO is a valuable psoriasis-specific HRQOL instrument in different populations.