Quality of Life Considerations in Psoriasis Treatment

Stefan C. Weiss, Kendra G. Bergstrom, Sally A. Weiss, Alexa B. Kimball

Disclosures

Dermatology Nursing. 2003;15(2) 

In This Article

Abstract and Introduction

Psoriasis can have a profound impact on a patient, interfering in all aspects of life. Therefore, measuring the impact of disease and the effects of treatment must include both physiologic measurements as well as health-related quality of life tools. Psychosocial evaluation of patients at risk allows for early interventions that will promote positive patient outcomes and compliance with the treatment pathways.

Dena was diagnosed with psoriasis at 8 years of age. Now a 33-year-old graduate student, she must find a way to satisfy her desire for intimacy in the setting of her skin disease. Haunted by the poor self-esteem and self-concept secondary to a distorted body image, Dena remains challenged by intimate situations ("Opening Up," 2002). Sarah, a 22-year-old preschool teacher, was embarrassed to wear shorts around her young students because of their questions and comments about her skin. One day, she sat the class down and explained that she had psoriasis. She told the class a little about the disease, and that it was not contagious. After that, the children stopped questioning her and she felt comfortable about not hiding her skin. These are but some of the many stories of patients with psoriasis.

Health-related quality of life (HRQL) is the summation of functional health, well-being, and participation. A measure of the patient's perception of the functional effect of an illness and its therapy, HRQL can distinguish the impact of a disease on two patients with an otherwise similar physical picture.

Four domains of HRQL have emerged as significant in the medical literature: physical and occupational function, psychological state, social interaction, and physical sensation. HRQL data are important because although physiologic data provide useful information to clinicians, they often correlate poorly with functionality and well-being, the areas that may be the most meaningful to patients. Therefore, the impact of disease on a patient's life is better assessed through the biopsychosocial framework that HRQL measures rather than relying on only physiologic outcome determinants (Badia, Mascaro, & Lozano, 1999; Chren, 1999; Gupta, Long, & Tillman, 1999; Rapp et al., 1999; Wahl, Moum, Hanestad, & Wiklund, 1999).

The interest in measuring HRQL has emerged from a desire to understand the effects of both illness and therapy on patients' lives. Despite evidence to suggest that HRQL instruments are good predictors of individual morbidity and mortality from disease, they have not been widely adopted in clinical practice. HRQL tools, however, have found utility in research, specifically in clinical trials and more controversially in cost analyses.

HRQL encompasses multiple dimensions. General measures, such as the Medical Outcomes Study Short Form-36 (SF-36) and EuroQol 5D (EQ-5D), address HRQL along the dimensions of physical, emotional, and social functioning as well as pain and role performance. General measures like these can be used to compare across different disease states; however, they are often not able to provide specific data regarding the impact of a single disease. Consequently, many disease-specific HRQL instruments have been developed. These metrics tend to address the same general categories but the questions are more focused. Examples include SkinDex, Dermatology Life Quality Index (DLQI), and the Cardiff Acne Disability Index.

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