Elsevier

Dermatologic Clinics

Volume 30, Issue 2, April 2012, Pages 281-291
Dermatologic Clinics

Quality-of-Life Instruments: Evaluation of the Impact of Psoriasis on Patients

https://doi.org/10.1016/j.det.2011.11.006Get rights and content

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Definition of QoL

QoL is a broad term used to evaluate the general well-being of an individual. It is meant to encompass all variables that may impact an individual’s life, including physical, social, and psychologic factors. Some authors define QoL as an individual’s perception of his or her position in life, in relation to his or her life goals and belief system.9 Health-related QoL is a more limited concept used to describe the effects that a disease or its symptoms have on an individual’s life. In terms of

Importance of QoL evaluation

There are many reasons why it is especially important to measure the impact of psoriasis on a patient’s QoL. Perhaps the most significant reason is in determining appropriate therapy for psoriasis. Presently, there are several highly effective, systemic therapies for psoriasis, such as cyclosporine, methotrexate. and the biologics including etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and ustekinumab (Stelera). There are also many new systemic and biologic therapies

Health-related QoL instruments

Health-related QoL instruments are questionnaires designed to assess the impact of a disease on a patient’s QoL. These QoL instruments can be generic, specialty-specific (ie, dermatology-specific), or disease-specific (ie, psoriasis-specific). Most have been developed for adult patients, but a few have been designed for children. To be a useful QoL instrument, it should demonstrate the following criteria: (1) validity (ie, the instrument evaluates well what it intends to measure); (2)

QoL instruments for psoriasis

Several useful generic, dermatology-specific, and disease-specific QoL instruments exist to evaluate the impact of psoriasis on patient’s QoL.9, 10, 11, 12 Specifically, generic QoL instruments given to patients with psoriasis include the Short Form 36 (SF-36),13, 14 the Sickness Impact Profile (SIP),15 the General Health Questionnaire (GHQ),16 and the Psychological General Well-Being Index (PGWB).17 The dermatology-specific QoL instruments commonly administered to patients with psoriasis

Short Form 36

The SF-36 is a 36-question survey that measures eight broad health dimensions: (1) physical functioning, (2) social functioning, (3) role limitations caused by physical problems, (4) role limitations caused by emotional problems, (5) general mental health, (6) energy and fatigue, (7) bodily pain, and (8) general health perception.13, 14 In addition, there is a question regarding the change in general health in the past year. The SF-36 is scored from 0 (worst health state) to 100 (best health

Dermatology-specific QoL instruments

The dermatology-specific instruments allow for psoriasis to be compared with other skin conditions.

Children’s Dermatology Life Quality Index

The CDLQI, published in 1995, is the children’s version of the DLQI. It was standardized on 169 children (ages 3–16 years), who presented to a pediatric dermatologic clinic. The CDLQI was developed based on what these children, with the assistance of their parents, described to be all the ways in which their skin disease affected their lives. The CDLQI has a similar structure to the adult DQLI and has the same scoring system. Specifically, it is a 10-item text-only questionnaire (maximum score

Psoriasis-specific QoL instruments

The psoriasis-specific instruments are the most sensitive and comprehensive to psoriasis. As such, they are best in two scenarios. The first is to detect small changes in psoriasis-specific QoL, which is relevant in both the clinical setting and in interventional trials. The second scenario is the need to elaborate what aspects of psoriasis is most important to the patient. The following instruments fit in these scenarios in differing ways.

Summary

Psoriasis results in a significantly negative QoL impact for a large portion of the affected population. Although psoriasis may not be life-threatening, it is a potentially life-ruining disease with multiple comorbidities in addition to the psychosocial implications. Fortunately, there are many new systemic treatment options available, such as biologic agents, which more effectively treat psoriasis not just for the short-term, but also for the long-term maintenance of control. However, when

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    Conflicts of Interest Disclosure: JWW, TVN, MMH, ESL, and TB have no financial conflicts of interest to disclose. JYMK has the following conflicts of interest: Abbott, Amgen, Leo, Galderma, Glaxo-Smith-Klein, PhotoMedex, Pfizer, and Teikoku. AM has the following conflicts of interest: Abbott, Amgen, Astellas, Celgene, Centocor, Eli Lilly, Galderma, Genentech, Novartis, Novo Nordisk, Pfizer, Promius, Stiefel, Syntrix Biosystems, Warner Chilcott, and Wyeth. There were no funding sources for this manuscript.

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