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A systematic literature review on quality of life in adult patients with psoriasis.

Byline: S Rahman, Nisaruddin, S Aman, N Sultan, G Butt, A Rahman and A Ahmad

Keywords Quality of Life; Heath Related Quality of Life; Psoriasis; Systematic Literature Review.

Introduction

Psoriasis is a common, chronic, recurrent, and inflammatory skin disease leading to the appearance of red scaly patches on the skin. This disease often arises between the ages of 15 and 35 years based on the geographical region and 2-3% of the population is affected by it. 1 However, psoriasis is generally more severe if begins in childhood as compared to the appearance of the disease in adulthood. 2 Systemic treatments, phototherapy, and topical treatments are available for psoriasis, however, there is no cure for it, and it requires lifelong monitoring of the patients. Moderate to severe cases of psoriasis are treated with phototherapy and systemic treatments while topical treatments are recommended for mild to moderated cases of psoriasis. 3

Psoriasis is a serious condition affecting the skin appearance and the severity varies among different patients. 4-6 Rash, itching, dry skin, constant peeling skin, pain 7, physical discomfort, emotional distress, and limitation in daily activities can adversely affect patients and their family member's daily lives. 8-14 These conditions have a significant negative effect on a patient's quality of life (QoL) even though psoriasis is a benign disease. 15, 16

QoL is the understanding of how a patient's health condition positively or negatively affects the social, physical and psychological functioning in daily life. 17 Patients of psoriasis experience both emotional and physical instability that directly affects their daily life. 12, 18 Moreover, the income of a psoriasis patient has a negative correlation with psoriasis and can diminish the QoL of psoriasis patients. 19 It is the reason that QoL has been considered for the chronic skin diseases that is a significant measure for dermatological conditions in clinical practice and trials of interventions. 20,21 Various QoL measurement tools are used to examine the efficacy of treatments that includes psoriasis specific, skin-specific and generic. The understanding and assessment of disease severity and effectiveness of interventions using QoL have become very important for advancing patient's care. 22

Extensive research has been conducted on the patient's QoL due to its popularity in dermatology, however, the patient reported outcomes (PRO) can also affect a patient's QoL. PRO is the direct response of a patient without interpretation by the clinician or anybody else about treatment satisfaction, quality of life (QoL) and preferences of treatment 23, and the effect of PROs on QoL has also been studied in recent years. The objective of this review was to assess and summarize the most related and recent data on QoL in psoriasis patients. Also, to identify the main factors that significantly influence QoL and to establish the impact of the disease in the patient's QoL.

Material and methods

Three international electronic databases (PubMed, EMBASE, and Web of Science) were searched for the research conducted between 1 January 2007 till 30 September 2017. The main keywords used were "Psoriasis" ("Psoriases", "Psorias?s"), "Quality of Life", and "Health-Related Quality of Life". MeSH terms and keywords are combined using the Boolean operators (OR, AND, NOT). The search was limited to research reported in English-language only and studies on humans.

All studies that examined the HRQoL or QoL in patients with Psoriasis were included. Studies whose primary object was to describe HRQoL or QoL, testing QoL questionnaires, and examining efficacy and safety of treatment for psoriasis were included in the study. All the studies that were published before the year 2007, and those that do not deal with QoL in psoriasis patients, and in non-English language were excluded from this review.

The search yielded 765 citations and a total of 637 were excluded based on their irrelevancy or duplicity. On the remaining 128 citations, the inclusion/exclusion criteria were applied and 58 full articles on HRQoL or QoL on psoriasis patients were retrieved. After reviewing the retrieved articles 30 were found to have examined the QoL in patients with psoriasis while the remaining 28 studies reported different treatments for patients with psoriasis (Figure 1). Thus, this systematic literature review describes 30 original articles that examined the HRQoL or QoL on patients with psoriasis published over the last 10 years and the research reported was in the English language.

Table 1 Studies included in the systematic literature review

Article###1. Sample Size###HRQoL###Predictors assessed for###Aims and Objective###Conclusion

Reference Study Design###2. Male: Female###Instrument###HRQoL

###Ratio

###Anxiety, Depression,###To understand the impact of###Patients with psoriasis were impaired in

43###Cross-###1. 3,485###DLQI###Sexual Functioning, Age###different skin disease on sexual###their sexual life and the impact was

###Sectional###2. 44:56###Differences###functioning###associated with itching, depression,

###anxiety and suicidal thoughts

###Anxiety, Depression,###Examining the interrelationships###More than half of the patients with

37###1. 368###DLQI###Gender Differences, and###between QoL and emotional and###psoriasis reported a significant negative

###2. 52:48###Age Differences###demographic factors in patients###change in their QoL

###with psoriasis

###Disease Severity, Work###Evaluating the variations of QoL###The severity of psoriasis is directly

32###Retrospective###1. 694###DLQI, EQ-###and Productivity###and work productivity in patients###proportional to lower QoL and work

###Study###2. 55:45###5D###with mild, moderate and severe###productivity

###psoriasis

###Anxiety and Depression###To investigate the level of QoL,###Psoriasis significantly impairs the QoL

45###Cross-###1. 84###DLQI###social activities and###of life of patients physically and

###Sectional###2. 49:51###anxiety/depressing in patients with###psychologically

###psoriasis

###Disease Severity and Age###To analyze the QoL in patients with###Family history of psoriasis leads to

39###Cross-###1. 1,022###DLQI###a family history of psoriasis and by###impair QoL and the impact of psoriasis

###Sectional###2. 60:40###age###was more noticeable in younger

###patients

###Sexual Functioning,###To evaluate the impact of genital###Patients with genital psoriasis are

42###Cross-###1. 354###DLQI###Gender Differences, Age###psoriasis on QoL and sexual###significantly impaired in sexual life and

###Sectional###2. 58:42###Differences###functioning###QoL

###Anxiety, Depression, and###Assessing the HRQoL in patients###Psoriasis patients HRQoL were

46###Cross-###1. 62###DLQI, EQ-###Pain/Discomfort###with psoriasis###severely impaired in the dimension of

###Sectional###2. 76:24###5D###anxiety, depression, pain, and comfort.

33###Cross-###1. 100###DLQI###Disease Severity###Examining the QoL in psoriasis###Psoriasis significantly reduces the

###Sectional###2. 50:50###patients and the severity of psoriasis patient's QoL

###Disease Severity and###Identifying factors impacting the###Diseases severity and symptoms like

47###Cross-###1. 414###SF-36###Pain/Discomfort###HRQoL of psoriasis patients###itching, burning sensation, and nail

###Sectional###2. 68:32###involvement were important factors

###affecting patient's HRQoL

###Gender Differences###To evaluate the relationship###Patient's gender, disease's duration and

40###Retrospective###1. 395###DLQI###between characteristics of psoriasis###the type of treatments were major

###Study###2. 60:40###and comorbidities with QoL###factors associated with impaired QoL

###Gender Differences and###To examine the effect on the QoL###Patient's physical and psychological

41###Cross-###1. 49###SF-36###Age Differences###of patients with nail psoriasis###wellbeing was affected by nail psoriasis

###Sectional###2. 53:47

###Anxiety, Depression, and###To analyze patient with moderate to###Patients with moderate to severe

###Gender Differences###severe psoriasis to determine the###psoriasis significantly impair HRQoL.

34###Cross-###1. 1,022###DLQI,###correlation between HRQoL and###Female patients are more affected in

###Sectional###2. 60:40###SF-36###the comorbidities###psychological components as compared

###to men.

###Disease Severity, Age###To evaluate and compare the###The severity of psoriasis has a

19###Cross-###1. 83###DLQI,###Differences, and###psoriasis patient's financial status###significant negative impact on a

###Sectional###2. 54:46###WHOQL-###Economical Burden###with disease severity and its effect###patient's economic status and leads to

###BREF###on QoL###impairment of QoL

###Disease Severity and###Investigating the cost of illness in###The financial burden of psoriasis

30###Cross-###1. 200###DLQI,###Economical Burden###patients with psoriasis and its###considerable affect the QoL of patients

###Sectional###2. 68:32###EQ-5D###impact on their QoL###with psoriasis

###DLQI,###Gender Differences, Age###Evaluating the self-reported###Persons with self-reported skin

48###Cross-###1. 15,177###EQ-5D,###Differences, and Sexual###dermatological HRQoL in###morbidity had lower HRQoL than the

###Sectional###2. N. A###Skindex-29###Functioning###the general population###general population

###Disease Severity,###To examine the effect and factors###Disease severity has a significant

36###Cross-###1. 223###DLQI###Pain/Discomfort, Work,###associated with HRQoL in patients###negative impact on HRQoL in patients

###Sectional###2. 53:47###and Productivity###with psoriasis in Malaysia###with psoriasis. Moreover, psychological

###factors also impair patient's HRQoL

###Anxiety, Depression,###Analyzing the HRQoL in patients###Most significant factor impairing

35###Prospective###1. 1,217###DLQI,###Pain/Discomfort, and Age###with moderate to severe Psoriasis###HRQoL in patients with psoriasis is

###2. 39:61###EQ-5D, PDI###Differences###disease severity

###Disease Severity,###Investigating the effect of psoriasis###Psoriasis negatively affect the QoL of

###Anxiety, Depression,###in patient's QoL in Malaysia and###patients in Malaysia and the financial

31###Cross-###1. 250###DLQI,###Gender Differences, Age###the cost of illness in psoriasis###burden is subsidized by the government

###Sectional###2. 54:46###SF-12v2###Differences, Work,###patients###of Malaysia

###Productivity, and

###Economical Burden

###Gender Differences, Age###To examine the physical and###Psychosocial, personal, and

49###Cross-###1. 692###EQ-5D###Differences, Sexual###psychological burden on the###professional relationships and QoL of

###Sectional###2. 42:58###Functioning, and###patients of psoriasis in Australia###patients are severely impaired by

###Economical Burden###psoriasis

###Disease Severity###Evaluating the QoL, severity of###The higher severity of psoriasis leads to

50###Retrospective###1. 404###DLQI,###psoriasis, and treatment satisfaction###lowest QoL in patients

###Study###2. 64:36###EQ-5D###in patients of psoriasis

###Anxiety and Depression###Analyzing the psychological###Anxiety and depression strongly

26###Cross-###1. 282###SF-36,###distress in patients with psoriasis###impairs the HRQoL in patients with

###Sectional###2. N. A###WHOQL###and its association with HRQoL###psoriasis

###Anxiety and Depression###Comparing different stress types on###Women with skin diseases are found to

44###Retrospective###1. 77###HAM-A,###the psychological wellbeing and###be more afflicted with family stress and

###Study###2. 35:65###HAM-D###their QoL of patients with skin###anxiety and depression correlates to

###diseases###each other

###Disease Severity,###Examining the relationship of###Pain/comfort of patients has a

###Anxiety, Depression, and###pain/comfort on HRQoL in patients###significant relationship on the patient's

25###Cross-###1. 139###DLQI###Pain/Comfort###with psoriasis and to identify if###HRQoL and secondly, the severity of

###Sectional###2. 43:57###psychological conditions are###psoriasis was directly associated with

###mediators of the relationship###HRQoL

###Self-###Anxiety, Depression,###Understanding the impact of###QoL and sexual functioning is impaired

28###Administered###1. 487###DLQI###Gender Differences, and###psoriasis in the patient's sexual###in patients with psoriasis and women

###Questionnaire###2. 57:43###Sexual Functioning###functioning and the attention given###with psoriasis were more inflicted by

###to it by the physicians###sexual distress

###Disease Severity, Gender###Evaluating the factors impairing the###Psoriasis significantly impairs the

24###Cross-###1. 110###SF-36,###Differences, Age###HRQoL in psoriasis patients###HRQoL in patients as compared to

###Sectional###2. 47:53###Skindex-29###Differences, and Sexual###other diseases

###Functioning

###Disease Severity, Work,###Examining the correlation between###Impaired QoL is strongly related to the

29###Cross-###1. 897###DLQI###Productivity, and###QoL, work and productivity, and###financial burden on psoriasis patients

###Sectional###2. 58:42###Economical Burden###economic burden in patients with

###psoriasis

###Disease Severity, Work###Impact of nail psoriasis on patient's###Nail involvement is directly related to

51###Cross-###1. 3,531###DLQI###and Productivity###QoL###the severity of psoriasis and the QoL

###Sectional###2. 56:44###impairment in patients with psoriasis

###Disease Severity, Work###Understanding the effect of###Severe psoriasis has been found to have

###and Productivity###psoriasis on the social and###a strong negative impact on the

38###Cross-###1. 590###DLQI,###professional life of patients and to###patient's QoL and their financial status

###Sectional###2. 51:49###WPAI###evaluate the cost of illness in

###patients with psoriasis

###Work, Productivity, and###Evaluating the work productivity of###Moderate to severe psoriasis has a

27###Not mentioned###1. 79###WPAIQ###Economical Burden###patients with moderate to severe###significant impact on the work

###2. N. A###psoriasis in Canada###productivity of the patients

###Disease Severity, Work,###Investigating disease severity,###Patient's with psoriasis are impaired in

52###Cross-###1. 1,151###DLQI###and Productivity###HRQoL and health care in psoriasis###their work and productivity and they

###Sectional###2. 58:42###patients in Germany###have significant impairment in HRQoL

Results

A. Characteristics of Included Studies

The maximum number of studies included in the review were cross-sectional studies (73.3%) followed by retrospective studies (13.3%) and only 3.3% were prospective design studies. The selected studies used 7 different instruments for measuring QoL in patients with psoriasis. The most commonly used instruments were the Dermatology Life Quality Index (DLQI), EuroQoL 5D (EQ-5D), and 36-item short-form survey (SF-36) (Table 1).

DLQI is a simple 10-question skin-specific questionnaire and is the most frequently used instrument for measuring QoL in psoriasis. The questions are answered on a 4-point scale where the higher score value will indicate the lowest HRQoL 16. In addition, EQ-5D is used in a wide range of treatments and health conditions as a measure for QoL. This instrument covers 5 dimensions including self-care, mobility, pain/discomfort, anxiety/depression, and usual activities 16. Lastly, SF-36 is a QoL measure that relies upon the patient's self-reporting outcomes and consists of eight sections where each scale can be scored on a value from 0 to 100. The lower score indicates more disability and the higher score of SF-36 indicates less disability 16.

B. QoL Impairment by Psoriasis

The studies included in this review were to understand the significant negative impact of psoriasis on a patient's QoL. A study conducted in Poland on psoriasis patient's quality of life determined that psoriasis significantly impair the patient's QoL. 19 They added that disease severity is the main factor that negatively affects a patient's financial status resulting in a lower quality of life. They called their findings as alarming and suggested equal employment opportunities for patients with psoriasis. Similarly, Jankovic et al. 24 reported that QoL in psoriasis patients are significantly low and specifically in older patients, as compared to the general population, however, gender and disease severity were not related in lower QoL.

Psoriasis has also been found to have a substantial impact on a patient's physical health 25, psychological health 26, professional life 27, social activities 28, and financial status. 19,29-31 Authors have suggested that each item on QoL instruments should be considered to gain in-depth insight into patient's QoL and to improve it not only physically but also psychologically and socially. 14

C. Impact of Psoriasis Severity, Age, and Gender, and Geography on QoL

Psoriasis Severity More than half of the studies (16 out of 30 studies) have investigated the effect of psoriasis severity on the patient's QoL. The results were very consistent in case of disease severity and reported that the disease severity is related to lower QoL in psoriasis patients. 19,32-34. In addition, moderate to severe psoriasis were found to have significantly affected QoL in patients. Psycho-social factors affecting patients QoL like stigmatization, lower self-esteem, poor social interactions were also found to be associated with disease severity. 31,35,36 These factors were mostly impaired with patients with moderate to severe psoriasis. However, PetraA!kiene et al. 37 found that psoriasis has a significant negative impact on patient's quality of life regardless of the severity of the disease.

Disease severity also has an impact on the physical factors of psoriasis including severe itching, pain, and scaling on skins of patients. Both, the disease severity and these factors were found to have a direct relationship where moderate to severe psoriasis patient has severe itching and pain on the affected areas of the body. 32 Moreover, work productivity and patient's financial status were also affected by disease severity and in turn, resulted in lower QoL in patients with psoriasis. Studies have found that patients with moderate to severe psoriasis have substantially impacted their work productivity and have put an economic burden on patient. 27,31,32,38

In the case of nationality, the results were also consistent, and studies showed that disease severity is considered a major factor in the impairment of the patient's QoL. In a study conducted on Malaysian patients with psoriasis reported that disease severity is the most important factor in the impairment of patient's QoL. 31 Also, a study on French patients demonstrated that severe psoriasis impacted both the physical and psychological health of patients. 38 In addition, Korman et al. 32 studied psoriasis patients of the USA and found that psoriasis severity has a significant negative impact on the patient's QoL.

Age, Gender and Sexual Functioning The relationship between age, gender, and sexual functioning of psoriasis patients with QoL was analyzed in 13 studies included in this review. Results were inconsistent in these studies and their relationship was found to be weak in some cases and strong in other cases. The negative impact of psoriasis on QoL in young patients was noticed, however, in older patients with earlier psoriasis has increased comorbidities like depression, anxiety, and sleep disturbance. 24,31, 39. Similarly, Fernandez-Torres et al. 40 and Van Der Velden et al. 41 also found that young patient's QoL was more impaired as compared to older patients where older patients reports to have many issues in their daily life activities while younger patients are psychologically distressed.

Van Der Velden et al. 41 added that increasing age results in acceptance of the fingernail psoriasis disease in patients. However, PetraA!kiene et al. 37 found that older patients mostly complain about psychological factors impaired by psoriasis.

Moreover, the impact of psoriasis on QoL in different genders has been extensively studied and most of the studies showed that female patients with psoriasis are more affected as compared to male psoriasis patients. 37,40,41 However, Tang et al. 31 found in their study of Malaysian patients that the QoL was effected by psoriasis equally in both genders. On the other hand, no relation was found between gender and QoL in patients with psoriasis 24. These conflicting results found in various studies can be the reason for the composition of the study groups or the gender differences in the duration of the disease.

Lastly, psoriasis also leads to impairment of sexual functioning in patients. Patients with psoriasis were found to have a higher prevalence of genital involvement that causes substantial impairment in their sexual functioning and QoL. 42 A study conducted by Sampogna et al. 43 on patients with psoriasis in 13 different European countries has found that psoriasis has a strong negative impact on a patient's sexual life that further leads to impairment of their QoL. They also reported that the impairment of sexual functioning also leads to comorbidities like anxiety, depression, and suicidal thoughts over time. Furthermore, psoriasis diminishes the sexual functioning along with QoL and it was found particularly in female patients with psoriasis. These impairments are more severe in patients with lesions in the genital area of female patients 28.

D. Anxiety and Depression in Psoriasis Patients and its impact on QoL.

Different scales have been used for measuring the anxiety and depression in patients with psoriasis including the Hospital Anxiety and Depression Scale (HADS) and Hamilton Scales for Anxiety and Depression (HAM-A and HAM-D). Old and female patients with psoriasis have been the target of anxiety and depression that leads to a decrease of QoL. 37 Both anxiety and depression were also found by Campolmi et al. 44 to have a higher impact on female psoriasis patients that leads to impairment of QoL. Similarly, Kouris et al. 45 also found in their study that anxiety and depression are the resultant of psoriasis that in turn impairs QoL of the patients.

A study conducted on psoriasis patients of Iran on the impairment of QoL found that anxiety and depression were the most frequent outcomes of the disease that significantly impacts the patient's QoL. 46 Another extensive study conducted on Spanish patients with psoriasis also found similar outcomes of anxiety and depression in psoriasis patients. The most affected group was female and their QoL was found to have decreased significantly 34. Tang et al. 31 compared healthy subjects with patients with psoriasis and has found a lower QoL in patients with psoriasis in that anxiety and depression play an important role.

E. Impact of Pain/Discomfort level in Psoriasis Patients on QoL.

The relationship of pain/discomfort was examined in 5 different studies included in this review. One of the main factors found in psoriasis patients of Iran was pain/discomfort that significantly impair the QoL of patients. 46 The scale used for measuring this factor was the EQ-5D where 50% of patients were affected by up to some extent and 12.9% of patients experienced a severe problem due to pain/discomfort. Similarly, Nyunt et al. 36 Found that the disease severity in patients with psoriasis has an impact on the pain/discomfort of the patients that leads to impairment of QoL.

Furthermore, Dauden et al. 35 in their study of Spanish patients with psoriasis noted that pain/discomfort was the main dimension in psoriasis patients that affect their mental health and that in turn leads to lower QoL. However, treatment of the disease resulted in the improvement of pain/discomfort dimension with the improvement of QoL. Similarly, pain/discomfort in psoriasis patients was found by Ljosaa et al. 25 in a Norwegian study to have a significant impact on patient's sleep disturbance leading to a decrease in QoL.

Discussion

This review was conducted to investigate the recent research on examining the QoL of patients with psoriasis. QoL was measured in the included articles with seven different instruments out of which DLQI was the most used instrument. Moreover, most of the studies suffered from weaknesses including small sample size, using non-statistical measures, and or in some cases use of a single question from the instrument for assessing the patient's QoL.

Despite these weaknesses, this review confirms that psoriasis significantly impairs the QoL of patients regardless of the type of psoriasis, and the impairments are physical, psychological, and social. Thus, this study provides important information on a patient's QoL affected by psoriasis and its comorbidities. Furthermore, studies have suggested that the in-depth analysis of each item in QoL instruments can deliver important information on psoriasis patient's most affected dimension of QoL. This will expose the psychological dimensions of psoriasis patients that need more attention in dealing with psoriasis.

Poorer QoL in patients with psoriasis was found in all the studies included in this review. A study conducted on 13 different European countries compared the impact of different skin diseases on a patient's QoL and especially the sexual impairment. 43 They found that psoriasis mainly affects patients' psychological dimensions and results in suicidal thoughts, depression and anxiety that are directly associated with the sexual functioning of psoriasis patients. In line with these findings, Meeuwis et al. 28 also found that psoriasis results in depression and anxiety and especially in young patients that directly impair their sexual life.

They found that female patients were more sexually impaired as compared to male patients and the most severely impaired were patients with skin lesions on their genital area. Moreover, a study based in Australia also confirmed that psoriasis negatively affects the sexual functioning of the patient along with financial burdens on the patients. 49 Several studies examined the disease severity and its effect on the QoL of psoriatic patients. Most of the studies identified that the disease severity significantly impairs the QoL of patients and reported that the more severe disease will lead to more severe impairment of QoL. 19,30,33,47

These studies found that patients with moderate to severe psoriasis has more impaired QoL as compared to patients with mild psoriasis. The impairment was both physical and psychological, however effects were mostly found on their psychological dimension and the depression and anxiety level rises with a rise in the severity of psoriasis. However, PetraA!kiene et al. 37 conducted a study on Lithuanian patients with psoriasis and found that psoriasis has a negative effect on patient's QoL but this negative impact is not associated with disease severity. From these findings, it is clear that the psychosocial problem including sexual functioning must be considered when assessing the severity of the disease.

Physicians and clinicians must consider the psychological dimension of patients with skin diseases and should consider creating a trusting relationship with psoriatic patients for effective treatment of the disease.

Extensive research has been conducted on the impairment of QoL in patients with psoriasis for the identification of different factors affecting QoL. A various number of factors that play the main role in impaired QoL are reported by some researchers, however, others have contradicted results in their research. For example, in case of the age and gender dimensions, most of the researchers found that the effect of psoriasis on patient's QoL is associated with their age and gender and are agreed that psoriasis affects QoL in young and female patients more as compared to old and male patients. 31,34

However, depression and anxiety dimensions are found to have more impaired in old patients as compared to young patients regardless of their gender 24. Furthermore, female patients were found to have been more socially impaired by psoriasis and feel more stigmatization as compared to male patients. 35,36 Therefore, special focus is required on female patients with psoriasis and dermatologists should always screen psoriatic patients for genital involvement and its impact on sexual functioning.

Economic burden was also one of the impacts on psoriatic patient's QoL and was found to have impaired their QoL. 19,49 Medical bills, absenteeism at work, and work productivity were the main factors found in current research affecting the patient's financial status. Balogh et al. 30 and Hawro et al. 19 found that economic burden due to psoriasis in patients substantially affects their QoL. In addition, disease severity was found to have a direct effect on a patient's economic status that leads to impairment of QoL. Similar results were also found by Sato et al. 29 and Baker et al. 49 that severity of psoriasis directly affects the financial status of patients resulting in lower QoL. However, in a study aimed at psoriatic patients in Malaysia found that the financial burden has no or very small effect on patient's QoL. 31

The reason given in their study mentioned is the low cost of medical treatment and subsidizing the cost of treatment by the Malaysian government on patients with chronic disease. Findings of research on the economic burden of psoriasis on patient's QoL are alarming and governments are required to devise a long-term solution for preventing the psoriatic patients from social exclusion.

Conclusion

Quality of life impairment is significantly related to psoriasis which is a chronic skin disease. Various instruments have been used in recent years to examine the effect of psoriasis on a patient's QoL. Similarities and contradictions have been found in assessing different dimensions of the patient's QoL in different studies. The psychological dimension including depression and anxiety along with pain/comfort and economic burden were found to impair QoL in patients with psoriasis. In addition, age and gender were found in several studies to have related to the patient's QoL while others show no relation of age and gender with QoL. Moreover, female psoriasis patients were found to be more sexually impaired as compared to male patients along with a high level of depression and anxiety. Therefore, a patient's psychological and social dimensions are a special focus of attention in seeking psychiatric treatment as these are more affected by psoriasis.

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Author:S Rahman, Nisaruddin, S Aman, N Sultan, G Butt, A Rahman and A Ahmad
Publication:Journal of Pakistan Association of Dermatologists
Geographic Code:9MALA
Date:Jun 30, 2020
Words:6620
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