Examining the Impact of Psoriasis Disease Burden on QOL, Mental Health

The health-related quality of life (HRQOL) impact of psoriasis was shown to be associated with severity of disease and location of lesion manifestations, according to findings of 2 abstracts presented at the 2022 American Academy of Dermatology (AAD) Annual Meeting.

As the prevalence, incidence, and morbidity of psoriasis has risen over the last 3 decades, prior research investigated the growing discussion regarding mental health and QOL in patients.

Patients with psoriasis have been shown to be at a heightened risk of depression and adverse behavioral health symptoms, in which comorbidities such as psoriatic arthritis and disease severity have been shown to exacerbate risk. The incidence of psoriasis in special areas (face, scalp, palms/soles, nails, genitals) was noted by researchers to also potentially increase disease burden.

Leveraging the multinational UPLIFT survey, a web-based survey of adults with self-reported health care provider–diagnosed psoriasis that was conducted from March 2 to June 3, 2020, they evaluated the impact of special area involvement on QOL outcomes and depression screening.¹

A total of 3614 patients with psoriasis who did and did not have special area involvement were compared via Dermatology Life Quality Index (DLQI) total score and Patient Health Questionnaire-2 (PHQ-2) depression screen measurements.

Of the study cohort, 76.8% (n = 2776) had psoriasis in att least 1 special area (face, 28.1%; scalp, 53.4%; palms/soles, 24.6%; nails, 16.7%; genitals, 12.2%).

Compared with patients without special area involvement, the mean (SD) DLQI scores were shown to be higher in patients who had psoriasis in 1 or more special areas overall (9.9 [8.5] vs 7.3 [7.3]). DLQI scores were shown to be highest for those with psoriasis in the face (12.4 [8.9]), palms/soles (11.7 [9.0]), and genitals (11.7 [9.0]), followed by nails (11.6 [9.1]) and scalp (9.5 [8.4]).

Patients with involvement in 1 or more special areas were also more likely than those without special area involvement to report that their psoriasis had at least a moderate effect on QOL (DLQI ≥ 6; 57.9% vs 47.5%) and to have a positive depression screen (PHQ-2 ≥ 3; 53.2% vs 44.1%).

A greater proportion of patients with psoriasis in 1 or more special areas (43.3%) had a DLQI scores of 6 or above and PHQ-2 of 3 or higher vs patients without special area involvement (32.8%).

“Results of the UPLIFT survey underscore the additional QOL and psychological burdens of psoriasis for patients with special area involvement vs those without involvement in special areas,” concluded the researchers.

The HRQOL impact on patients with psoriasis was further investigated by another analysis that assessed how improvements in Psoriasis Area and Severity Index (PASI) were associated with the achievement of DLQI 0/1 (no impact of skin disease on patient’s life).²

Pooled data from the initial 16-week periods of the BE SURE, BE VIVID, BE READY, and BE RADIANT phase 3/3b trials evaluating the use of several biologics in plaque psoriasis was included in the analyses.

Analyses included 2223 randomized patients with psoriasis who presented with a mean baseline PASI of 20.4 and a mean baseline DLQI of 10.7 (bimekizumab, n = 1362; placebo, n = 169; ustekinumab, n = 163; adalimumab, n = 159; secukinumab, n = 370).

Findings indicated that ​​incremental PASI improvements translated to higher rates of patients achieving DLQI 0/1:

• Estimated percentage of patients achieving DLQI 0/1 was 85.5% (95% CI, 83.3%-87.4%) with 100% PASI improvement
• Estimated percentage of patients achieving DLQI 0/1 was 78.6% (95% CI, 75.9%-81.0%) with 95% PASI improvement
• Estimated percentage of patients achieving DLQI 0/1 was 69.5% (95% CI, 66.5%-72.3%) with 90% PASI improvement
• Estimated percentage of patients achieving DLQI 0/1 was 58.6% (95% CI, 55.4%-61.8%) with 85% PASI improvement
• Estimated percentage of patients achieving DLQI 0/1 was 46.8% (95% CI, 43.6%-50.1%) with 80% PASI improvement
• Estimated percentage of patients achieving DLQI 0/1 was 35.4% (95% CI, 32.3%-38.5%) with 75% PASI improvement

“These data highlight the importance of complete skin clearance for patients with plaque psoriasis and suggest that for patients who respond to treatment, but do not achieve complete skin clearance, residual disease may still negatively impact HRQOL,” said the researchers.

References

1. Langley RG, Augustin M, McBride S, et al. Impact of psoriasis in special areas on patient quality-of-life outcomes and depression screening: Findings from the multinational UPLIFT survey. Presented at: 2022 American Academy of Dermatology Annual Meeting; March 25-29; Boston, MA. Abstract 33950.

2. Blauvelt A, Lebwohl M, Gottlieb A, et al. Complete skin clearance for patients with moderate to severe plaque psoriasis: The relationship between improvements in Psoriasis Area and Severity Index and health-related quality of life. Presented at: 2022 American Academy of Dermatology Annual Meeting; March 25-29; Boston, MA. Abstract 33884.