The Effect of Treatment on Quality of Life in Psoriasis Patients
doi: 10.1080/00015550510027801
Abstract:
Psoriasis is a chronic skin disease with substantial impact on patients' social and relational ways of living and subsequently on their quality of life. The aim of this study was to evaluate the health-related quality of life (HRQoL) of patients with moderate to severe psoriasis treated with short contact dithranol treatment, UVB phototherapy or inpatient dithranol treatment. HRQoL was evaluated in an open randomized multicentre study by appliance of the Dutch short form of the Sickness Impact Profile and the Psoriasis Disability Index; 250 patients were included. Successful short contact dithranol treatment and UVB phototherapy both led to a comparable improvement in HRQoL immediately after treatment until the end of the follow-up (maximum 1 year). Inpatients experienced a more impaired HRQoL and showed no significant improvement in HRQoL directly following treatment. At the end of the study HRQoL became comparable for all treatment groups. All three treatments led to substantial improvement in HRQoL; however, patients treated by short contact treatment or UVB showed a better HRQoL than inpatients.
Key words:
health-related quality of life, inpatient treatment, purpura, short contact dithranol treatment, UVB phototherapy
References:
- Staquet, M. J. and Hays, R. D. and Fayers, P. M.(1998) Quality of life assessment in clinical trials.. In . Oxford : Oxford University Press.
- Ginsberg, I. H. and Link, B. G. (1989) Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol, 20, pp. 53 - 63.
- Leary, M. R. and Rapp, S. R. and Herbst, K. C. and Exum, M. L. and Feldman, S. R. (1998) Interpersonal concerns and psychological difficulties of psoriasis patients: effects of disease severity and fear of negative evaluation. Health Psychol, 17, pp. 530 - 536.
- Ginsberg, I. H. and Link, B. G. (1993) Psychosocial consequences of rejection and stigma feelings in psoriasis patients. Int J Dermatol, 32, pp. 587 - 591.
- Wahl, A. and Hanestad, B. R. and Wiklund, I. and Moum, T. (1999) Coping and quality of life in patients with psoriasis. Qual Life Res, 8, pp. 427 - 433.
- Lebwohl, M. and Tan, M. H. (1998) Psoriasis and stress. Lancet, 351, pp. 82.
- Wall, A. R. and Poyner, T. F. and Menday, A. P. (1998) A comparison of treatment with dithranol and calcipotriol on the clinical severity and quality of life in patients with psoriasis. Br J Dermatol, 139, pp. 1005 - 1011.
- Koo, J. Y. (1999) Current consensus and update on psoriasis therapy: a perspective from the U.S. J Dermatol, 26, pp. 723 - 733.
- Hartman, M. and Prins, M. and Swinkels, O. Q. J. and Severens, J. L. and de Boo, T. and van der Wilt, G. J. and (2002) Cost-effectiveness analysis of a psoriasis day care instruction programme with dithranol compared to UVB phototherapy and inpatient dithranol treatment. Br J Dermatol, 147, pp. 538 - 544.
- Swinkels, O. Q. J. and Prins, M. and Veenhuis, R. T. and de Boo, T. and Gerritsen, M. J. P. and van der Wilt, G. H. and (2004) Effectiveness and side effects of UVB-phototherapy, dithranol inpatient therapy and a care instruction programme of short contact dithranol in moderate to severe psoriasis. Eur J Dermatol, 14, pp. 159 - 165.
- Finlay, A. Y. and Khan, G. K. and Luscombe, D. K. and Salek, M. S. (1990) Validation of sickness impact profile and psoriasis disability index in psoriasis. Br J Dermatol, 123, pp. 751 - 756.
- Finlay, A. Y. (1998) Skin disease disability: measuring its magnitude. Keio J Med, 47, pp. 131 - 134.
- Marks, R. and Barton, S. P. and Shuttleworth, D. and Finlay, A. Y. (1989) Assessment of disease progress in psoriasis. Arch Dermatol, 125, pp. 235 - 240.
- Fredriksson, T. and Pettersson, U. (1978) Severe psoriasis – oral therapy with a new retinoid. Dermatologica, 157, pp. 238 - 244.
- de Bruin, A. F. and Diederiks, J. P. M. and de Witte, L. P. and Stevens, F. C. and Philipsen, H. (1994) The development of a short generic version of the sickness impact profile. J Clin Epidemiol, 47, pp. 407 - 418.
- McKenna, K. E. and Stern, R. S. (1996) The outcomes movement and new measures of the severity of psoriasis [see comments]. J Am Acad Dermatol, 34, pp. 534 - 538.
- de Bruin, A. F. and Buys, M. and de Witte, L. P. and Diederiks, J. P. M. (1994) The sickness impact profile: SIP68, a short generic version. First evaluation of the reliability and reproducibility. J Clin Epidemiol, 47, pp. 863 - 871.
- Finlay, A. Y. (1997) Quality of life measurement in dermatology: a practical guide. Br J Dermatol, 136, pp. 305 - 314.
- Finlay, A. Y. (1998) Quality of life assessments in dermatology. Semin Cutan Med Surg, 17, pp. 291 - 296.
- Haishma, H. H. and Kaptein, A. A. and Thio, B.Social aspects of psoriasis, the Psoriasis Disability Index.. In . 6th international Congress on Dermatology and Psychology, Amsterdam, The Netherlands
- Koo, J. (1996) Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin, 14, pp. 485 - 496.
- Finlay, A. Y. (1995) Quality of life issues and economic burden of psoriasis. Clin Drug Invest, 10((Suppl. 1)), pp. 1 - 6.
- Root, S. and Kent, G. and al Abadie, M. S. (1994) The relationship between disease severity, disability and psychological distress in patients undergoing PUVA treatment for psoriasis. Dermatology, 189, pp. 234 - 237.
- Finlay, A. Y. and Kelly, S. E. (1987) Psoriasis-an index of disability. Clin Exp Dermatol, 12, pp. 8 - 11.
- McKenna, K. E. and Stern, R. S. (1997) The impact of psoriasis on the quality of life of patients from the 16-center PUVA follow-up cohort. J Am Acad Dermatol, 36, pp. 388 - 394.
- Kurwa, H. A. and Finlay, A. Y. (1995) Dermatology in-patient management greatly improves life quality. Br J Dermatol, 133, pp. 575 - 578.
- Wahl, A. (1997) The impact of psoriasis on psychosocial life domains. A review. Scand J Caring Sci, 11, pp. 243 - 249.
- Wahl, A. and Moum, T. and Hanestad, B. R. and Wiklund, I. (1999) The relationship between demographic and clinical variables, and quality of life aspects in patients with psoriasis. Qual Life Res, 8, pp. 319 - 326.
- de Bruin, A. F. and Diederiks, J. P. M. and de Witte, L. P. and Stevens, F. C.SIP68, a short form of the Sickness Impact Profile.. In [SIP68, een verkorte versie van de Sickness Impact Profile]. Maastricht, Rijksuniverstiteit Limburg. ( pp. 1 - 36 ).
- Finlay, A. Y. and Coles, E. C. (1995) The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol, 132, pp. 236 - 244.
- Fortune, D. G. and Main, C. J. and O'Sullivan, T. M. and Griffiths, C. E. (1997) Quality of life in patients with psoriasis: the contribution of clinical variables and psoriasis-specific stress. Br J Dermatol, 137, pp. 755 - 760.
Novel Quantitative Immunofluorescent Technique Reveals Improvements in Epidermal Cell Populations after Mild Treatment of Psoriasis Mirella W. F. M. van DuijnhovenA1, Ronald HagenbergA1, Marcel C. PaschA1, Piet E. J. van ErpA1, Peter C. M. van de KerkhofA1 A1 Department of Dermatology, UMC St Radboud, Nijmegen, The Netherlands A novel antibody labelling technique, the Zenon technique, was used in fluorescent immunohistochemistry for a better characterization of epidermal cell populations in a quantitative approach. With this technique, differences in proliferation and differentiation characteristics were shown between psoriatic and normal epidermis. The sensitivity of the method was investigated by assessing the effect of a mild topical treatment versus an emollient. Frozen sections of non-treated psoriatic epidermis and psoriatic epidermis treated once daily with either an emollient or betamethasone-17-valerate for only 2 weeks were compared immunohistochemically. Antibodies against keratin 6, 10 and 15 were labelled with the Zenon technique, whereas antibodies against the Ki-67 antigen and β-1 integrin were covalently FITC-labelled. Using image analysis, these markers were measured in the epidermis in a standardized manner. Treatment of psoriasis with short-term topical steroid resulted towards normalization of Ki-67 antigen, β-1 integrin, keratin 10 and keratin 6 expression, which are parameters for proliferation and differentiation. Although treatment with an emollient showed hardly any clinical response, changes towards a more normal phenotype could already be detected in several epidermal markers using this method.
|