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Quantifying the harmful effect of psoriasis on health-related quality of life,☆☆,

A portion of these data was presented in oral and poster form at the annual meeting of the American Academy of Dermatology, March 2001.
https://doi.org/10.1067/mjd.2002.122755Get rights and content

Abstract

Background: Psoriasis affects 7 million people in the United States, causing substantial cost, social stigma, and disability. Objective: The purpose of this study was to evaluate the health effects of skin disease by comparing psoriasis to other primary medical disorders using 3 different scales of health-related quality of life. Methods: A self-administered questionnaire consisting of 3 health-related quality of life measures was given sequentially to 35 eligible patients with psoriasis presenting to the Dermatology Branch of the National Cancer Institute (NCI) for an investigational therapeutic protocol. Results: All patients (100%) agreed to participate. The median Psoriasis Area and Severity Index (PASI) score was 13.0. Overall, 82.9% at least often felt the need to hide their psoriasis, and 74.3% claimed their self-confidence was at least often affected by their psoriasis. The median EQ-5D health state utility score was 13.0% less than healthy individuals (P < .001). On the SF-36, the mean general health score was 13.2% less (P = .005) and the median social functioning score 18.7% less (P = .005) than that of patients with no chronic conditions. Conclusion: Individuals with psoriasis are significantly affected in their health state utility, perception of general health, and social functioning when compared with individuals without chronic disease and those with certain primary medical conditions. (J Am Acad Dermatol 2002;47:512-8.)

Section snippets

Patients

A total of 35 consecutive patient-subjects, older than 18 years, who spoke English and presented at various stages of an ongoing National Institutes of Health (NIH) randomized double-blind placebo-controlled trial evaluating recombinant human interleukin 10 (IL-10) for moderate to severe psoriasis were invited to participate (response rate: 100%). No subject was paid to participate. The protocol and survey instruments were approved by the Office of Human Subjects Research at the NIH Warren G.

Statistical analysis

For each dependent variable (SAPASI, SWB, EQ-5D [utility and VAS score], and the SF-36 [general health, body pain, social functioning, mental health, role-physical, vitality]), a stepwise multiple linear regression analysis was performed to ascertain which, if any, of the independent variables (PASI, age, sex, race, marital status, education, employment, 6 questions of patient impact, perception of general health, the number of comorbidities, physical pain, and a previous diagnosis of

Patient characteristics

Table I provides the sociodemographic characteristics of the 35 patients who completed the self-response questionnaire.

. Number (percent) of patients with PASI or SAPASI scores <10 or ≥10 by group for the indicated characteristics and P-values for the test of association between the characteristic groups.

CharacteristicGroupPASI < 10 n (%)PASI ≥ 10 n (%)PSAPASI < 10 n (%)SAPASI ≤ 10 n (%)P
Age (y)<495 (29)12 (71).725 (29)12 (71).72
≥497 (39)11 (61)7 (39)11 (61)
SexMale6 (29)15 (71).487 (33)14 (67)

Discussion

The importance of skin disease has often been underrecognized by society; however, nearly half of a population surveyed in the United States indicated they would rather have a medical condition generally considered more dangerous, such as hypertension or asthma, than a skin condition like psoriasis.37, 38 By illustrating that the effect of psoriasis on quality of life is substantial using 3 standard metrics that evaluate well-being, this study provides additional quantitative evidence to

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    This research was conducted as part of on-going work at the National Institutes of Health; no outside funding was sought.

    ☆☆

    Conflict of interest: None.

    Reprint requests: Alexa B. Kimball, MD, MPH, 900 Blake Wilbur Dr, Room W0024, Stanford, CA 94305. E-mail: [email protected].

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