|Year : 2016 | Volume
| Issue : 2 | Page : 111-114
Psoriasis can markedly impair the quality of life of patients irrespective of severity: Results of a hospital-based cross-sectional study
Ajith Vettuparambil, Neelakandhan Asokan, Beena Narayanan
Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
|Date of Web Publication||30-Jun-2016|
Government Medical College, Thrissur, Kerala - 680 596
Source of Support: None, Conflict of Interest: None
Background and Objectives: There are conflicting opinions in previous studies whether the quality of life (QoL) of patients with psoriasis is affected by its severity. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching hospital in central Kerala, India; and to find out if severity of psoriasis as measured by psoriasis area severity index (PASI) affects the QoL. Materials and Methods: We did a cross-sectional study of 49 patients with psoriasis. QoL was assessed using the Malayalam version of the Dermatology Life Quality Index (DLQI). PASI was used to calculate the clinical severity of the disease. We calculated Spearman's rank correlation coefficient between these two scores. Results: Thirty-three (67.3%) patients had marked (moderate or above) impact on overall QoL. Among the various domains of the QoL, symptoms and feeling were found to be affected most, followed by work and school and daily activities. There was no significant correlation between PASI and the overall DLQI (Spearman r = 0.131, P = 0.37), though the domain of leisure activities showed moderately significant positive correlation (Spearman r = 0.037; P = 0.03) with PASI. Conclusion: Psoriasis markedly affects the QoL of the sufferers, especially in the domains of symptoms and feeling, work, and school as well as daily activities. This study does not provide evidence that impairment of QoL is related to severity of psoriasis.
Keywords: Kerala, psoriasis area severity index (PASI), psoriasis, quality of life (QoL)
|How to cite this article:|
Vettuparambil A, Asokan N, Narayanan B. Psoriasis can markedly impair the quality of life of patients irrespective of severity: Results of a hospital-based cross-sectional study. Muller J Med Sci Res 2016;7:111-4
|How to cite this URL:|
Vettuparambil A, Asokan N, Narayanan B. Psoriasis can markedly impair the quality of life of patients irrespective of severity: Results of a hospital-based cross-sectional study. Muller J Med Sci Res [serial online] 2016 [cited 2017 Apr 29];7:111-4. Available from: http://www.mjmsr.net/text.asp?2016/7/2/111/185010
| Introduction|| |
Psoriasis is a common, chronic, multifactorial disease mainly affecting skin and joints. Psoriasis can impair the quality of life (QoL) of affected patients.  Various aspects of daily living such as social interactions, looking after one's household, dressing, job, or schooling can be affected by the disease. Interpersonal as well as sexual relationships may be affected as well. The cost and time required for treatment coupled with the difficulty of using topical creams and ointments can additionally worsen the QoL.
Several previous studies, from India and abroad, have explored the association between clinical severity of psoriasis and the QoL. ,,,,,,,, Finlay et al., Aghaei et al. and Rakhesh et al. reported that the severity of the disease is related to the degree of impairment of the QoL; but Fortune et al. and Yang et al. failed to note such an association. ,,,, So we decided to explore this topic in our population. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching hospital in central Kerala, India; and to find out if impact on the QoL is related to the severity of psoriasis as measured by psoriasis area severity index (PASI).
| Materials and Methods|| |
We did a cross-sectional study of 49 patients who attended the Dermatology outpatient department (OPD) of the Government Medical College, Thrissur Kerala, India, over a period of 6 months (May 2011 to October 2011). Patients aged 16 years or above, who had psoriasis for at least 3 months were included in the study. Malayalam version of the Dermatology Life Quality Index (DLQI) questionnaire was used for assessing the QoL. 
DLQI is a reliable, validated 10-item questionnaire covering six dimensions (symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment) that assess the overall impact of skin disorders and current treatments on the patient's functioning and well-being. Effect on the QoL can be grouped into five, based on the total score. [No effect (0-1), small effect (2-5), moderate effect (6-10), very large effect (11-20), and extremely large effect (21-30)]. PASI was used to calculate the clinical severity of the disease. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). These data as well as demographic and clinical data of the patients were collected using a proforma.
Data obtained were analyzed using Statistical Package for the Social Sciences (SPSS) (SPSS for Windows version 11.5, SPSS Inc, Chicago, Illinosis). Spearman's correlation coefficient was used to find out the association between PASI score and score of overall DLQI as well as individual domains of DLQI. Chi square test was used to find out the association of DLQI with various demographic and clinical factors such as age, sex, educational, and occupational status of patients, duration of disease, history of substance use, and involvement of joints. Statistical significance was defined as P-value <0.05.
| Results|| |
Out of 49 subjects, 39 (79.6%) were males [Table 1]. Three (6.1%) patients gave a family history of psoriasis. Six (12.2%) patients had clinically evident joint involvement, 12 (24.5%) had diabetes mellitus, and seven (14.3%) had systemic hypertension. PASI was 10 or less in 30 (61.2%), 11-20 in 14 (28.6%), and more than 20 in five (10.2%) patients.
|Table 1: Demographic and clinical characteristics of the study population|
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Thirty-three (67.3%) patients had marked (moderate or above) impact on overall QoL [Table 2]. Among the various domains of QoL, symptoms and feeling were found to be affected most, followed by work and school, and daily activities [Table 3]. There was no significant correlation between PASI and overall DLQI (r = 0.131, P = 0.37). Though the domain of leisure activities (r = 0.307; P = 0.03) showed moderately significant positive correlation with PASI, the domains of symptoms and feeling, daily activities, work and school, personal relationship and treatment did not. Group comparison of the DLQI score with respect to educational status, occupation, and religion is showed in [Table 4].
|Table 3: Domains of quality of life affected in patients with psoriasis (n = 49) and their correlation with PASI|
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Additionally, there was no statistically significant correlation for DLQI with age (P = 0.767), sex (P = 0.463), educational (P = 0.916), and occupational status (P = 0.847), duration of the disease (P = 0.258), concurrent diseases (P = 0.433), substance use (P = 0.264), or joint involvement (P = 0.738) of the patients.
| Discussion|| |
We found that psoriasis had a marked impact on overall QoL of most patients. Symptoms and feeling was the most commonly affected domain in our study population, followed by work and school, daily activities, personal relationships, treatment, and leisure activities. Rakhesh et al. and Manjula et al. found daily activities to be the most commonly affected domain of QoL, using psoriasis disability index (PDI). , Rakhesh et al. as well reported major impact in the domain of employment and treatment.  Finlay et al. found that psychosocial factors (personal, family-related, and social life) were more markedly affected than physical factors (daily activities and work-related factors). 
Finlay et al. reported a moderate correlation between extent of the disease and QoL as measured by PDI.  Rakhesh et al. and Pakran et al. as well reported a correlation between severity and disability as measured by PDI. , Hariram et al. reported a weak correlation of PASI with QoL as measured by DLQI and PDI.  Aghaei et al. reported a strong correlation between severity of disease with impairment of QoL as measured by both PDI and DLQI.  Shankar et al. showed a minimal positive correlation between PASI and QoL measured by psoriasis QoL questionnaire-12 (PQOL-12). 
We found no significant correlation between severity of psoriasis and overall QoL, as measured by DLQI. But there was a moderately significant correlation between severity and the individual domain of QoL related to leisure activities. Lack of correlation between severity and overall QoL was reported by Fortune et al. and Yang et al. as well. , Different conclusions in various studies could be due to either differences in the mean PASI scores of the study population or choice of different measures of QoL. Among the studies cited above, only Hariram et al. and Aghaei et al. used DLQI measure QoL, as we did. , Mean PASI score of our study subjects was 8.8; same as in the study by Fortune et al., but much lower than 22.23 as reported by Rakhesh et al. ,
Even though not statistically significant, we observed a steady increase in the impairment of QoL from illiterate to those who had education in college level, except in those with professional education. This may indicate a greater impact of the disease on social interactions in persons in higher social classes.
Our study has certain limitations. Since this is a hospital-based study, its findings cannot be extrapolated to all psoriatic patients in the community. Furthermore, though DLQI is a validated instrument, its Malayalam version was not pretested for validity among the local population.
| Conclusion|| |
Yet, the conclusions of the study that psoriasis markedly affect QoL of the sufferers, especially in the domains of symptoms and feeling, work, and school as well as daily activities; and that the overall impairment of QoL is not correlated with severity of psoriasis should lead to a better understanding of the relationship between psoriasis and QoL in our population. Awareness about the degree as well as the manner in which QoL is affected in psoriasis should prompt healthcare providers and policymakers to include concerns about the QoL more effectively in the overall treatment plan of patients with psoriasis. Treatment and support needs to be tailored to address the specific domains of QoL affected in each patient, apart from relieving the apparent physical symptoms of psoriasis.
We are extremely thankful to Professor Andrew Y. Finlay and Dr. Mohammad K. A. Basra for granting permission to use the Malayalam version of DLQI.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Basra MK, Shahrukh M. Burden of skin diseases. Expert Rev Pharmacoecon Outcomes Res 2009;9:271-83.
Rakhesh SV, D′Souza M, Sahai A. Quality of life in psoriasis: A study from south India. Indian J Dermatol Venereol Leprol 2008;74:600-6.
Shankar V, Ghosh S, Ghosh K, Chaudhuri U. PASI and PQOL-12 score in psoriasis: Is there any correlation? Indian J Dermatol 2011;56:287-9.
Manjula VD, Sreekiran S, Saril PS, Sreekanth MP. A study of psoriasis and quality of life in a tertiary care teaching hospital of Kottayam, Kerala. Indian J Dermatol 2011;56:403-6.
Pakran J, Riyaz N, Nandakumar G. Determinants of quality of life in psoriasis patients: A cluster analysis of 50 patients. Indian J Dermatol 2011;56:689-93.
Finlay AY, Khan GK, Luscombe DK, Salek MS. Validation of sickness impact profile and psoriasis disability index in psoriasis. Br J Dermatol 1990;123:751-6.
Fortune DG, Main CJ, O′Sullivan TM, Griffiths CE. Quality of life in patients with psoriasis: The contributions of clinical variables and psoriasis-specific stress. Br J Dermatol 1997; 137:755-60.
Yang Y, Koh D, Khoo L, Nyunt SZ, Ng V, Goh CL. The psoriasis disability index in Chinese patients: Contribution of clinical and psychological variables. Int J Dermatol 2005; 44:925-9.
Hariram P, Mosam A, Aboobaker J, Esterhuizen T. Quality of life in psoriasis patients in KwaZulu Natal, South Africa. Indian J Dermatol Venereol Leprol 2011;77:333-4.
Aghaei S, Moradi A, Ardekani GS. Impact of psoriasis on quality of life in Iran. Indian J Dermatol Venereol Leprol 2009;75:220.
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)-A simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:210-6.
[Table 1], [Table 2], [Table 3], [Table 4]