银屑病患者生活质量调查

目的:研究银屑病对患者生活质量的影响及皮肤病生活质量指数(DLQI)作为判断银屑病病情及疗效新指标的可信性。方法:采用DLQI研究银屑病患者治疗前、后的生活质量及其影响因素,并与传统的银屑病皮损面积和严重度指数(PASI)进行比较。结果:女性患者的DLQI评分明显高于男性,未婚者的DLQI评分高于已婚者,面部受累者的DLQI评分高于面部未受累者(P<0.05)。DLQI和PASI评分呈显著正相关(r=0.633,P<0.001)。治疗后随着临床病情的改善,PASI和DLQI评分均显著下降,且DLQI改善率和PASI改善率呈显著正相关(r=0.722,P<0.001)。结论:银屑病对患者生活质量的影响较大,DLQI可作为判断银屑病病情及疗效的新指标。     

Efalizumab for severe palmo-plantar psoriasis: an open-label pilot trial in five patients

Background  Palmo-plantar psoriasis (PPP) is a disabling condition that significantly impairs quality of life. PPP tends to be resistant to conventional therapies and may last for several years. Topical treatments are usually ineffective. Systemic therapy with oral retinoids and psoralen plus ultraviolet A is frequently required, although it rarely leads to remission.
Study design  We conducted an open-label, pilot study to evaluate treatment of PPP with efalizumab, an anti-CD11a monoclonal antibody approved for the treatment of chronic, refractory moderate to severe plaque psoriasis in adults.
Methods  Five patients with severe PPP received efalizumab treatment for 24 weeks.
Results  All five patients responded favourably by week 12 and showed further improvement at week 24 of uninterrupted therapy. Mean physician-assessed severity scores and patient-reported outcome scores improved almost 75% after 12 weeks and 90% after 24 weeks. At week 32, three patients maintained the response seen at week 24, while two patients suspended efalizumab.
Conclusions  Efalizumab therapy was well tolerated and effective in five patients with severe PPP, allowing a significant improvement in quality of life.

Conflicts of interest

None declared     

Evaluation of the efficacy and safety of infliximab on psoriatic nails: an unblinded, nonrandomized, open-label study

Background  Despite advances in the treatment of skin psoriasis during the last years, therapy of psoriatic nails remains a challenge.
Objectives  The objective of this unblended, nonrandomized, open-label study was to evaluate the efficacy and safety of infliximab on nail psoriasis.
Patients/Methods  Eighteen psoriatic patients with nail involvement, consecutively selected among patients scheduled to start infliximab infusions were included in the study. Thirteen of these patients had psoriatic arthritis and five had severe plaque type psoriasis. Outcome measures were assessed at baseline and at weeks 14, 22, 30 and 38 using the nail psoriasis severity index (NAPSI). Patients also filled in a Greek translation of the international onychomycosis-specific questionnaire to assess improvement in quality of life after improvement of psoriatic nail signs.
Results  All 18 patients completed the study. Significant improvement was noted in most patients after the third infusion as shown by the reduction of mean NAPSI (NAPSIm) from 55·8 at baseline to 29·8 at week 14. Evaluation after six infusions, at week 38, showed an almost complete resolution of psoriatic nail involvement (NAPSIm: 3·3). No adverse event was observed. All patients reported satisfaction with the results and significant improvement in their quality of life with reduction of the score of the international quality of life questionnaire from 66·3 at baseline to 19·1 at week 38.
Conclusions  Αlthough there is no control group, this data suggests that infliximab is effective for psoriatic nail disease in the context of severe skin and joint involvement.     

Timing of quality of life improvements in psoriatic patients treated with different systemic therapies

Psoriasis impacts the quality of life (QoL) by disrupting overall health and social life. Thus, the use of a QoL evaluation item is crucial in assessing a therapeutic regimen. Also, faster improvements in QoL lead to better patient compliance, but very few studies compare psoriasis traditional and biologic therapies timing. To evaluate how much different systemic therapies improve disease severity and QoL, a retrospective analysis was performed on 56 patients. Subjects were administered different drugs and their vital statistics, psoriasis area severity index (PASI) and PSOdisk were collected at baseline and after 30 days. We found a moderate correlation between PASI and PSOdisk score with (r): .62. In terms of clinical scores improvement after 30 days, Ustekinumab turned out to be the fastest therapy available, while cyclosporine, among the systemic therapies available, appeared as highly competitive if not better than other biologic therapies.     

Positive effect of modified Goeckerman regimen on quality of life and psychosocial distress in moderate and severe psoriasis

Psoriasis is a chronic inflammatory skin disease with a profound effect on quality of life and psychosocial stress. The relationship between clinical improvement and psycho-social impact after treatment is complex. The objective of this study was to compare changes in quality of life and psychosocial distress, and overall cost-effectiveness, in patients with psoriasis receiving the modified Goeckerman regimen (UV irradiation and coal tar) with those receiving conventional treatment. Patients with moderate/severe psoriasis receiving the Goeckerman regimen were followed from admission to discharge. Clinical severity, was evaluated weekly using the Psoriasis Area and Severity Index (PASI). Psoriasis Disability Index (PDI) and Hospital Anxiety and Depression Scale (HADS) questionnaires were applied at admission and one month after discharge. Thirty-six patients with psoriasis receiving conventional treatment and 48 patients receiving the Goeckerman regimen were recruited to the study. The mean PASI score in the Goeckerman group decreased from 27.1 to 6.9 and PDI scores decreased from 25.3 to 13.8. HADS scores for anxiety and depression decreased significantly from 9.8 to 6.3 and 9.1 to 6.8, respectively. In comparison with conventional therapy, the modified Goeckerman regime showed similar clinical efficacy, with additional benefits in improving overall quality of life and psychosocial distress in patients with moderate/severe psoriasis, and more cost-effectiveness.     

No long-term changes in psoriasis severity and quality of life following climate therapy

This paper describes disease severity and quality of life of 286 patients who underwent climate therapy. The lowest disease severity and better life quality occurred 2 weeks after therapy. However, by 4 and 8 months after therapy, all measures had returned to approximately the same level as before treatment.     

Health literacy in psoriasis care

Psoriasis is a long-lasting (chronic) skin disease, which affects 2% to 3% of the population in Scandinavia as well as the UK. Treatment generally requires a high level of self-management by patients, such as applying medications at home. Psoriasis can have several different treatment options, comorbidities (other diseases occurring alongside psoriasis) and lifestyle recommendations, which can be hard for patients to process. Health literacy (HL) is the ability to seek, understand and apply health information. Lower HL has been linked with poorer health outcomes (meaning less successful treatment) in several chronic conditions, but has not been studied in psoriasis. This study from Norway aimed to investigate the HL strengths and weaknesses of patients with psoriasis. The study included 825 patients with moderate to severe psoriasis who had participated in ‘climate helio therapy’ (use of natural sunlight) in Gran Canaria from 2011 to 2016. All completed questionnaires and The Health Literacy Questionnaire (HLQ) assessed HL. The study found that higher HL predicted higher quality of life and psoriasis knowledge. Sex, educational attainment, age and disease severity had less influence on health literacy. The study shows that improving HL may be a useful strategy for strengthening psoriasis self-management. Interventions that aim to reduce disease severity and increase psoriasis knowledge, self-management and quality of life may positively increase HL.     

Effectiveness of inpatient treatment on quality of life and clinical disease severity in atopic dermatitis and psoriasis vulgaris - a prospective study

BACKGROUND: Financial constraints challenge evidence of the effectiveness of dermatological inpatient management. OBJECTIVE: To evaluate the effectiveness of hospitalization in atopic dermatitis and psoriasis regarding initial and sustained benefits. METHODS: Prospective study on adults with psoriasis vulgaris (n = 22) and atopic dermatitis (n = 14). At admission, discharge, and 3 months after discharge, validated outcomes of objective and subjective disease severity were assessed by trained investigators. RESULTS: Hospitalization resulted in substantial benefit in quality of life and clinical disease severity. Looking at mean scores, the observed benefit appeared stable until 3-month follow-up. The analysis of individual patient data revealed significant changes in disease severity between discharge and 3-month follow-up with some patients relapsing, others further improving. Reasons for hospitalization and treatment performed were not related to sustained benefit. CONCLUSIONS: In psoriasis vulgaris and atopic dermatitis, hospitalization effectively improved quality of life and clinical disease severity. Further research should focus on prognostic factors for sustained improvement.     

Quality of psoriasis care in Germany – results of the national study PsoHealth 2007

Background: Many different forms of treatment are available for psoriasis. The German standard is the national AWMF S3 guideline. A national survey on psoriasis care in 2005 indicated deficits in psoriasis care in Germany. Aim: Assessment of the health care situation of patients with psoriasis in Germany. Methods: Nation‐wide cross‐sectional study, in 142 dermatological practices and clinics. The following data were documented: a) Doctor Questionnaire: Treatment, illnesses, clinical characteristics and severity (PASI). b) Patient Questionnaire: Quality of life (QoL), patient relevant therapeutic benefits and satisfaction with the quality of the care. A panel of experts developed and analyzed 8 criteria as indicators of the quality of care. Results: Of the 2009 evaluated patients, 11.6% suffered from severe psoriasis (PASI > 20) and 27.4% from moderate psoriasis (PASI 10–20). The average PASI value was 10.1, and the DLQI 7.5. 32.2% of patients had a serious reduction in their QoL (DLQI > 10). The share of patients with preceding systemic therapy was 47.3%, in severe psoriasis 62.1%, while 20.1% of the patients had received inpatient treatment. The average number of days absent from work was 3.4. Compared to 2005, all 8 indicators improved. Conclusion: Significant numbers of psoriasis patients show serious quality of life reductions and high grades of clinical severity. In comparison to 2005, there has been a notable, nation‐wide improvement in psoriasis care.     

Patient-reported outcomes of psoriasis improvement with etanercept therapy: results of a randomized phase III trial

BACKGROUND: Etanercept, a soluble tumour necrosis factor receptor, lessens the severity of psoriasis as measured by physician-reported clinical outcomes. Equally important is the patient perspective on the effect of etanercept therapy on daily life. OBJECTIVES: To assess patient-reported outcomes (PROs) in patients with psoriasis receiving etanercept therapy. METHODS: In this multinational, randomized, phase III trial, patients with psoriasis received placebo (n = 193), etanercept 50 mg per week (n = 196) or etanercept 50 mg twice weekly (n = 194) during the initial 12-week, double-blind period. Thereafter, all patients received open-label etanercept (50 mg per week). The following PROs were assessed: Dermatology Life Quality Index (DLQI), Short Form-36 Health Survey (SF-36), patient rating of pruritus, and patient global assessment of psoriasis. RESULTS: At week 12, DLQI total score improved by 65-70% in patients receiving etanercept compared with 6% in patients receiving placebo (P < 0.0001), and improvement in DLQI was clinically meaningful (> or = 5-point improvement or 0 score) for 72-77% of patients receiving etanercept therapy. All DLQI and SF-36 subscales and the SF-36 physical and mental component summary scores demonstrated significantly greater improvement with etanercept therapy than with placebo, illustrating that etanercept benefits patients with psoriasis across multiple domains that contribute to health-related quality of life. With etanercept therapy, distributions of patient ratings of pruritus and global assessment of disease shifted from moderate to severe (baseline) to minimal to good (week 12). Etanercept-induced benefits of PROs were maintained for patients who reduced their dose after 12 weeks. CONCLUSIONS: Etanercept therapy improves PROs in patients with psoriasis and makes a meaningful difference to their lives. These results support the efficacy profile of physician-reported clinical measures while providing a more complete understanding of the benefits experienced by patients with psoriasis treated with etanercept.     

Impairment of sexual life in patients with psoriasis

BACKGROUND: Sexual life can be severely affected in patients with psoriasis. However, this component is not often assessed by clinicians. OBJECTIVE: To estimate the prevalence of sexual impairment and its degree of association with clinical and personal factors among psoriasis patients. METHODS: Sexual life impairment was investigated in all eligible adults hospitalized with psoriasis in a dermatological hospital from February 2000 to February 2002, using answers to specific items from two dermatology-specific questionnaires, and from two psoriasis-specific questionnaires. Clinical severity and psychological problems were also evaluated. The same questionnaires were collected a month after hospital discharge, to estimate changes from baseline. RESULTS: Of 936 patients,from 35.5% (Psoriasis Disability Index) to 71.3% (Impact of Psoriasis on Quality of Life Questionnaire) reported to have experienced sexual problems because of psoriasis. A more severe disease and the presence of psychological problems were also associated with sexual impairment. At 1-month follow-up, a reduction of >75% in clinical severity was associated with a twofold probability of substantial improvement of sexual life. CONCLUSIONS: Sexual impairment is very frequent in patients with psoriasis. Single questions on sexual life from quality of life questionnaires provide a simple tool that may be useful in clinical practice to assess sensitive issues, and thus to provide better patient-physician communication.     

Efficacy of a far erythemogenic dose of narrow-band ultraviolet B phototherapy in chronic plaque-type psoriasis

The aim of the present study was to examine the effect of far erythemogenic dose of narrow-band ultraviolet B (NB-UVB; starting dose at 35% minimal erythematous dose [MED]) on clinical response by measuring the severity, extent of disease and the changes in quality of life. Fifty patients with chronic plaque-type psoriasis were enrolled. Therapy was held for 3 days a week. The severity of the disease was assessed based on the Psoriasis Area and Severity Index (PASI) score and Dermatology Life Quality Index (DLQI) scores. The percentage improvement of PASI at 30 sessions was 68.99%. The improvement in DLQI scores at 30 sessions was 79.67%. Pearson correlation coefficients showed that PASI scores were not correlated with DLQI scores at the beginning of treatment ( P  = 0.330, r  = 0.14), but after the 30th session of NB-UVB therapy improvements in quality of life were correlated ( P  < 0.05, r  = 0.399). Therefore, far erythemogenic dose of NB-UVB is considered to be effective treatment for plaque-type psoriasis in our patients. However, we cannot confirm that it is safer than higher MED starting dose in term of cumulative UV irradiation.     

Cost-effectiveness analysis of TNF-α blockers for the treatment of chronic plaque psoriasis in the perspective of the Italian health-care system

The cost-effectiveness of biological treatments for psoriasis is not well determined and may vary from country to country. The objectives of this study was to perform a cost-effectiveness analysis of infliximab compared with other anti-tumor necrosis factor-α agents for the treatment of psoriasis in Italy. The incremental cost-effectiveness ratio per patients achieving at least 75% improvement in the psoriasis area and severity index assessed over 24- and 48–50-week periods was calculated. Efficacy data were drawn from randomized controlled trials when available or from open label studies. Considering patients achieving psoriasis area and severity index at week 24 and 48–50, infliximab was dominant (more effective and less costly) over etanercept given at 50 mg twice weekly. In contrast, infliximab was not dominant over etanercept at other dosages or over adalimumab. When considering the impact of therapy on quality of life at Week 12 using the Dermatology Life Quality Index equal to zero, infliximab resulted more effective and less costly than etanercept. Therefore, infliximab seems to be cost-effective in the therapy of psoriasis. Further cost-efficacy evaluations based on head-to-head trials are necessary to address health economic considerations.     

Biomarkers of psoriasis severity and therapy monitoring

Psoriasis is a chronic, recurrent inflammatory cutaneous disease. Psoriasis patients alternate between periods of remission and periods of exacerbation of the disease. Usually, psoriasis severity is clinically evaluated using tools like Psoriasis Area and Severity Index that present some limitations and subjectivity. Clinicians select the therapy according to psoriasis severity, aiming that patients achieve longer remission periods and improve their quality of life. Biological markers for diagnosis and prognosis of psoriasis help to establish its severity and to monitor the therapeutic response; moreover, biomarkers of psoriasis assist clinicians in their therapeutic decision to treat psoriasis and to choose earlier and more adequate therapeutic strategies, avoiding or minimising worsening of psoriasis. With these markers, they would be able to monitor therapeutics, avoiding unnecessary therapeutic surcharge or changes to a more aggressive therapy. As any attempt to identify these biomarkers should be encouraged, in this review, we will debate published data concerning the proposal of biomarkers to evaluate severity and response to treatment of psoriasis vulgaris.     

Biomarkers of psoriasis severity and therapy monitoringSusa

Psoriasis is a chronic, recurrent inflammatory cutaneous disease. Psoriasis patients alternate between periods of remission and periods of exacerbation of the disease. Usually, psoriasis severity is clinically evaluated using tools like Psoriasis Area and Severity Index that present some limitations and subjectivity. Clinicians select the therapy according to psoriasis severity, aiming that patients achieve longer remission periods and improve their quality of life. Biological markers for diagnosis and prognosis of psoriasis help to establish its severity and to monitor the therapeutic response; moreover, biomarkers of psoriasis assist clinicians in their therapeutic decision to treat psoriasis and to choose earlier and more adequate therapeutic strategies, avoiding or minimising worsening of psoriasis. With these markers, they would be able to monitor therapeutics, avoiding unnecessary therapeutic surcharge or changes to a more aggressive therapy. As any attempt to identify these biomarkers should be encouraged, in this review,we will debate published data concerning the proposal of biomarkers to evaluate severity and response to treatment of psoriasis vulgaris.     

The Norwegian version of the dermatology life quality index: a study of validity and reliability in psoriatics

The aim of this study was to test the Norwegian version of the Dermatology Life Quality Index (DLQI-N) for validity and reliability in psoriatic patients. The DLQI-N was administered to 230 patients with psoriasis who underwent climate therapy on Gran Canaria, with a dermatologist assessing their psoriasis severity using the Psoriasis Area and Severity Index. Factor analyses resulted in a unidimensional pattern, which supports the use of a total DLQI-N score. The internal consistency coefficient of this unidimensional measure was 0.90 (Cronbach's alpha) and the paired inter-item correlations ranged from 0.20 to 0.76 (p < 0.01). Questions related to work, sport and sex were the issues most often ticked off as not relevant, and the item related to working/studying was often misunderstood. DLQI-N scores were significantly associated with disease severity, age and sex. We assess DLQI-N as a valid, reliable and clinically useful outcome measure for quality of life in Norwegian patients with psoriasis.     

Comparison of psoriasis and atopic dermatitis guidelines—an argument for aggressive atopic dermatitis management

The development of effective systemic treatments has revolutionized the treatment of inflammatory skin diseases. The availability of safe new treatments and the understanding of psoriasis as a systemic disease with comorbidities and effects on quality of life have driven the current aggressive treatment paradigm of psoriasis. Historically the morbidity of atopic dermatitis (AD) has been dismissed, given the perception of AD as “just” a rash. Differences in the guidelines for psoriasis and AD management may suggest variations in the current conceptualization of disease severity and effects on quality of life. Published guidelines from the American Academy of Dermatology for the management of psoriasis and AD were reviewed. We recorded the similarities and differences in disease assessment and therapy. The threshold to use biologic agents for moderate to severe psoriasis highlights the aggressive nature of modern psoriasis treatment. AD guidelines include an assessment of quality of life but do not designate a disease severity threshold for systemic treatment. AD and psoriasis have a tremendous effect on quality of life. The AD guidelines have a less aggressive approach to disease management than the psoriasis guidelines. We should think critically about rapid advancement to systemic agents in AD management, especially now that more and better agents are being developed.     

Effective treatment and improvement of quality of life in patients with scalp psoriasis by topical use of calcipotriol/betamethasone (Xamiol®‐gel): results

Background: Quality of life of patients with scalp psoriasis is greatly impaired due to itch and scaling. To control the disease long‐term therapy is necessary and treatment success is greatly dependent on compliance. Patients and Methods: In a prospective, non‐interventional trial in German dermatological practices 721 patients with scalp psoriasis received Xamiol^® gel (calcipotriol 50 μg/g, betamethasone 0,5 mg/g) topically for 4 weeks. Severity was assessed by physician's global assessment (PGA) and quality of life by using a scalp‐specific questionnaire at the beginning of the study and after 4 weeks of treatment. Results: The mean disease severity of scalp psoriasis (PGA) improved from 4.26 to 2.49 (–41.8 %, p < 0.0001) during 4 weeks of treatment and quality of life improved from 10.57 to 3.22 (–69.5 %, p < 0.0001). Among patients with pre‐treatment 89.5 % of patients and 87.9 % of dermatologists judged treatment response to Xamiol^® gel as better/much better compared to previous therapy. Tolerability of Xamiol^® gel was rated good/very good by 98 % of dermatologists and patients, respectively. The use of Xamiol^® gel was found easy/very easy by 90.4 % of the patients. Conclusions: Due to the major improvement of quality of life and quick onset of improvement together with the high acceptance by the patients Xamiol^® gel may be regarded as the topical treatment of choice for scalp psoriasis.     

Severe cutaneous and arthritic psoriasis in patient with AIDS: a good outcome with therapy using etanercept

We report the case of a patient with cutaneous and arthropathic psoriasis for eight years, whose sudden increased severity of the clinical picture led to a diagnosis of AIDS, emphasizing the importance of the specialist in the diagnosis of systemic diseases. The appropriate therapeutic interventions, including antiretroviral therapy and the immunobiological agent etanercept, enabled rapid improvement of symptoms and quality of life of the patient, besides contributing to delay in immunodeficiency progression.     

Impact of psoriasis in the quality of life of children,adolescents and their families: a cross-sectional study

Background: Psoriasis is a chronic and inflammatory disease that impairs quality of life and causes psychological symptoms. Despite the high prevalence of psoriasis in pediatric patients, studies investigating the impact of psoriasis in the quality of life of children, adolescents and families are sparse.Objective: To investigate the impact of psoriasis in the quality of life of children and adolescents with psoriasis and their families and to determine depression and anxiety levels of the patients.Methods: A total of 58 patients with psoriasis aged 7-18 years (median age: 11) and a family member of each patient were included in the study. Children’s Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), Children’s Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIC) were used in the study.Results: The median PASI score of the patients included in the study was 1.8. The median CDLQI and FDLQI scores in the study groups were 5 and 10, respectively. The median CDI score, STAIC-state and STAIC-trait scores of the patients were 6, 28 and 32.5, respectively.Study limitations: Lack of a control group and patient assessment of disease severity. Relatively mild disease severity of the subjects.Conclusions: Psoriasis has a negative impact in the quality of life of children, adolescents and their families, even in the presence of mild disease. Considering that impairment in quality of life may be associated with psychosocial morbidity, a combined approach with medical therapy, family counseling and quality of life assessment may be beneficial in this patient group.