Type D personality is associated with poor quality of life, social performance, and psychological impairment in patients with moderate to severe psoriasis: A cross-sectional study of 130 patients.

BACKGROUND: Psoriasis is a systemic autoinflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D personality has been related to poor quality of life and worse physical and psychological outcomes in different diseases. AIMS: The aim of this study is to explore whether type D personality is associated with an increased risk of presenting physical and/or psychological comorbidities, their relationship with the capacity of social adaptation, and health-related quality of life (HRQOL) in patients with psoriasis. METHODS: This was a cross-sectional study. In all, 130 patients with moderate to severe psoriasis were included in this study. Participants completed the DS14 test and different validated questionnaires regarding quality of life and psychological morbidities. RESULTS: Type D personality was present in 38.4% (50/130) of the participants of the study. Patients with psoriasis and type D personality presented a higher risk of depression and anxiety. We observed that type D personality was associated with a lower educational level. These patients also presented a worse HRQOL in different dimensions of the Short Form Health Survey-36 questionnaire, more sleep problems, poor social adaptation, and a higher frequency of sexual disturbances. LIMITATIONS: Due to the cross-sectional design of the study, we could not confirm causality. Selection of sample was not random. Diagnoses of physical comorbidity were collected through clinical interview of patients under active treatment, which may imply a classification bias. CONCLUSION: Type D personality could represent a frequent personality profile in patients with psoriasis that could identify subjects with poor coping abilities to the disease with poorer levels of quality of life, increased psychological comorbidities, and inadequate social adaptation mechanisms.

Stigmatization in dermatology with a special focus on psoriatic patients.

A stigma is currently defined as a discrediting mark, biological or social, that sets a person off from others and disrupts interactions with them. People who differ from social norms in some respect are often negatively labeled. A number of medical conditions are recognized at present as stigmatizing their sufferers and certain skin diseases are among them. The article aimed to analyze the current understanding about stigmatization among dermatological patients, especially those with psoriasis. We performed our search on PubMed up to November 2016 and utilized combinations of key phrases containing such words as stigmatization, skin, dermatology, names of various skin conditions (psoriasis, vitiligo, acne, etc.). Following a precise selection process, 58 articles remained. Stigmatization seems to be a common and important problem in dermatology. Psoriasis appears as the most frequently studied skin disease (37.2% of articles). It was followed by vitiligo (13.7%) and leprosy (8.6%). Mainly, the visibility of skin lesions as well as cultural factors contribute to the feeling of stigmatization. There is a need for more research in the field of stigmatization in dermatological conditions and an urgent need for the creation of special anti-stigmatization program/programs for patients suffering from dermatoses.

Screening for depressive disorders in outpatients with mild to moderate psoriasis: a study from North India.

BACKGROUND: Psoriasis and depressive disorders commonly occur together. Depressive disorders have an impact on the quality of life and the outcome of psoriasis. AIMS: The aim of this study was to test the feasibility of using a modification of the Hindi translation of the Patient Health Questionnaire-9 (PHQ-9) as a verbal, clinician administered, short screening questionnaire for detecting depressive disorders. MATERIALS AND METHODS: One hundred and four out-patients with psoriasis were recruited in the study. In the first stage of the study, socio-demographic data, Psoriasis Area Severity Index (PASI) score, and Dermatological Quality of Life (DLQI) score were recorded. The modified questionnaire was administered by the dermatologist. In the second stage, psychiatric diagnoses were confirmed using the Mini International Neuropsychiatric Interview. RESULTS: The prevalence of depressive disorders was 39.4%. Receiver operating curve (ROC) analysis showed that the questionnaire had a good discriminant ability in detecting depressive disorders (area under curve: 0.81, SE = 0.04, 95% confidence interval = 0.72-0.89). LIMITATIONS: The sample size is small and more studies are needed with the screening questions in different languages to validate the findings of the study. CONCLUSION: The questionnaire can be a useful screening instrument for detecting depressive disorders in patients with psoriasis.

A measurement of the stigma among vitiligo and psoriasis patients in India.

BACKGROUND AND AIM: The aim is to measure and to compare the level of social participation experienced by vitiligo and psoriasis patients in their domestic and social life in an Indian context. METHODS: A cross-sectional comparative study with a sample of 150 cases each of psoriasis and vitiligo, a total of 300 subjects. A detailed clinical assessment of these two conditions, including the extent of lesions on the affected body parts, socioeconomic status and participation levels in social and domestic lives, was done. RESULTS: The result showed that, 17.3% of vitiligo patients participated minimally in domestic and social life, whereas 28% of psoriasis patients had this problem (P=0.027). Extreme participation restriction was observed only among psoriasis patients (2.7%). Psoriasis patients also faced significantly more restrictions in a number of day-to-day life situations such as, less confidence in learning and applying knowledge, difficulties in meaningfully participating in major life areas like, work, education and employment, and also in community, social and civic life (all three domains P<0.0001), to vitiligo patients. CONCLUSION: Both psoriasis and vitiligo patients suffered moderate to severe restriction while participating in their domestic and social life. Of these two groups, psoriasis patients faced significantly more restrictions in a number of day-to-day life situations. The Indian population of this study was predominantly dark-skinned and hypo-pigmentation as seen in vitiligo is much more noticeable than psoriatic red patches. However, the results showed that the component of hypo or hyperpigmentation of the skin is not the only factor leading to participation restrictions.

Impact of psoriasis on quality of life in Iran.

BACKGROUND: The Psoriasis Disability Index (PDI) questionnaire is a widely used instrument to measure psychological morbidity in plaque-type psoriasis patients. AIMS: This study aimed to validate the Persian version of the PDI and to evaluate the impact of psoriasis on quality of life (QOL). METHODS: The English language version of the PDI was translated into Persian (Iranian official language) and was used in this study. The questionnaire was administered to a consecutive sample of 125 chronic plaque-type psoriasis patients and statistical analysis was performed to evaluate the impact of psoriasis on QOL. The other health-related QOL assessment tool included the Persian version of the Dermatology Life Quality Index (DLQI). RESULTS: Overall, 125 patients who had received the PDI and DLQI completed all the questions. Reliability analysis showed a satisfactory result (Cronbach's a coefficient=0.92 and 0.79 for PDI and DLQI, respectively). There was a strong statistical correlation between mean PDI and DLQI scores, with mean Psoriasis Area and Severity Index (PASI) (P=0.005 and 0.02). Also, a significant correlation coefficient existed between DLQI and PDI (r=0.94). The higher the PASI index, the higher the PDI and DLQI scores, which indicated greater impact on QOL. In the patients with lesions on visible exposed skin areas, the correlation was statistically significant (P=0.002 and 0.01). CONCLUSION: The Persian PDI is an acceptable, reliable and valid measure of psychological distress, with more suitable content validity than DLQI for assessment of impact of psoriasis on QOL among psoriasis patients. Data provided may improve the physicians' awareness of the importance of the patients' QOL.

Quality of life in psoriasis: a study from south India.

BACKGROUND: Psoriasis can have a profound impact on a patient's quality of life. Very few Indian studies have examined this aspect of Indian patients of psoriasis. AIMS: This study was conducted to assess the clinical severity, as well as physical and psychosocial disability, and stress incurred and to analyze their interrelationship in psoriasis patients aged more than 18 years. METHODS: This hospital-based cross-sectional study was conducted in the Department of Dermatology, JIPMER, Pondicherry, India. Clinical severity, physical and psychosocial morbidity, and the stress incurred were measured using psoriasis area severity index (PASI), psoriasis disability index (PDI), and psoriasis life stress inventory (PLSI) respectively, the latter two of which were suitably modified and translated into the local language, viz., Tamil. Appropriate tests were conducted using SPSS for Windows (Release 7.5.1) statistical software. RESULTS: Fifty patients (34 males, 16 females) were included in the study. The clinical PASI scores correlated significantly with the overall physical disability (PDI), individual aspects of the PDI (except the treatment-related activities), and the measurement of stress incurred (PLSI). A PASI score of more than 18 delineated a subgroup of patients with higher overall physical disability and higher stress rating. Among the physical and psychosocial factors investigated, daily activities, employment, and treatment were reported to be affected the most. Psoriasis sufferers are also most likely to feel self-conscious, be disturbed / inconvenienced by the shedding of the skin, live in a constant fear of relapse, and avoid social interactions. CONCLUSIONS: The present study provides compelling evidence that psoriasis affects the quality of life, and it highlights the importance of adopting a multidimensional assessment of psoriasis.

Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria.

BACKGROUND: The possibility of a causal influence of emotional stress, especially of stressful life events, on the course of various skin diseases has long been postulated. Previous reports addressing its influence on skin psoriasis and chronic urticaria have been mainly anecdotal. OBJECTIVE: The aim of this study was to evaluate the stressful events of life within 1 year preceding onset or exacerbation of skin disease in patients of psoriasis vulgaris and chronic urticaria. METHOD: Fifty consecutive clinically diagnosed psoriasis patients and 50 consecutive clinically diagnosed chronic urticaria patients were examined clinically and administered Gurmeet Singh's presumptive stressful life events scale. RESULTS: Stressful life events were seen in 26% of the patients in the psoriasis vulgaris group and 16% of the patients in the chronic urticaria group within 1 year preceding onset or exacerbation of skin disease. In the psoriasis vulgaris group, the most common stressful life event seen was financial loss or problems (8%), followed by death of close family member (4%), sexual problems (4%), family conflict (2%), major personal illness or injury (2%), and transfer or change in working conditions (2%), failure in examinations (2%), family member unemployed (2%), illness of family member (2%), getting married or engaged (2%), miscellaneous (2%). In the chronic urticaria group, the most common stressful life event seen was death of a close family member (6%), followed by family conflict (2%), financial loss or problems (2%), sexual problems (2%), illness of family member (2%), getting married or engaged (2%), trouble at work with colleagues, superiors, or subordinates (2%), going on a pleasure trip (2%) and extramarital relations (2%). CONCLUSION: Psychological stress plays a significant role in triggering or exacerbating dermatological diseases. Our study indicates the role of relaxation therapies and stress management programs in chronic diseases such as psoriasis and chronic urticaria. Psychological interventions can help individuals to reinterpret events and develop strategies to cope with stressful events, thus decreasing morbidity due to these diseases.

Evaluation of functional impairment in psoriasis.

BACKGROUND: Psoriasis is a chronic disease, the course of which is punctuated by exacerbations and remissions. The impact of a chronic, relapsing, and disfiguring disease such as psoriasis on occupational, social, and other areas of functioning is substantial and needs attention. AIM: The purpose of this study was to assess the level and nature of functional impairment in psoriasis. METHODS: Forty-three consecutive patients attending the dermatology clinic of a rural hospital were studied for psychiatric comorbidity and the level of functioning, using a semistructured questionnaire. RESULTS: Psoriasis affected social functioning of 48% patients, led to decreased work efficiency in 51.1% and to subjective distress at work in 62.8% of patients. Stress in home environment and interpersonal relationships was reported by 69.8%. Social and occupational functioning worsened with increasing severity of psoriasis after 1-year duration of illness. Patients complaining of pruritus frequently had anxiety disorders. Psychiatric comorbidity was detected in 67.4% cases. CONCLUSION: Substantial proportion of patients suffered deterioration of functioning, especially with increasing duration of illness. Thus, timely attention by dermatologists is needed in order to limit the disability caused by psoriasis. To achieve this, liaison with psychiatrist would be crucial along with illness education and emotional support.

[Psoriasis, biblical afflictions and patients' dignity].

The currently accepted Hebrew word for psoriasis is 'sapachat'. The word 'sapachat' is biblical and its original meaning is unknown. Similar uncertainty applies also to the biblical word 'tzaraat', the currently accepted Hebrew term for leprosy. This article discusses possible explanations of the biblical terms 'sapachat' and 'tzaraat'. The link between 'sapachat' and psoriasis was made only several decades ago. The word 'sapachat' conveys a definite negative connotation, and imposes an emotional burden on psoriatic patients. We therefore recommend preferable use of the word 'psoriasis' and avoid using the offending term 'sapachat'.

Psoriasis, biblical afflictions and patients dignity

The currently accepted Hebrew word for psoriasis is 'sapachat'. The word 'sapachat' is biblical and its original meaning is unknown. Similar uncertainty applies also to the biblical word 'tzaraat', the currently accepted Hebrew term for leprosy. This article discusses possible explanations of the biblical terms 'sapachat' and 'tzaraat'. The link between 'sapachat' and psoriasis was made only several decades ago. The word 'sapachat' conveys a definite negative connotation, and imposes an emotional burden on psoriatic patients. We therefore recommend preferable use of the word 'psoriasis' and avoid using the offending term 'sapachat'.

Identidade e adoecimento: a representacao do processo saude-doenca em pacientes dermatologicos / Identity and illness: the representation of the health-disease process in dermatological patients

O objetivo deste trabalho foi o de investigar o processo de adoecimento e suas implicacoes na constituicao da identidade de pacientes com psoriase, assim como a compreencao da relacao entre o sujeito e sua doenca. Para isso foi realizada uma pesquisa qualitativa, utilizando-se entrevistas semi-estruturadas com pacientes psoriaticos adultos, em situacao de tratamento ambulatorial, cujo tempo de convivencia com a doenca fosse superior a 5 anos. Foi realizada um analise do discurso desses pacientes, com objetivo de compreender a relacao entre sua identidade e seu adoecimento. Dentre os varios aspectos evidenciados pudemos observar qua a psoriase, enquanto doenca cronica, toma grande importancia na vida de quem convive com ela. As dificuldades mais aparentes dizem respeito a convivencia com situacoes estressantes, com sentimentos de rejeicao e revolta, bem como com signifivativas restricoes nas atividades socializadoras. A presenca constante de situacoes conflitantes aparece como outro fato marcante na percepcao dos pacientes, pois, o estabelecimento de vinculos afetivos, com pessoas significativas, costuma se dar com elevado grau de tensao emocional e sofrimento psiquico. O aspecto fisico provocado pela psoriase tende a criar um sentimento de repulsa, levando a percepcao de uma auto-imagem significativamente desfavoravel. A vivencia dos conteudos psiquicos, pelos pacientes, na relacao com a doenca, os levaram a incorporar caracteristicas tipicas do adoecimento como sendo proprias de sua identidade. A pele serve, nesse contexto, como campo de expressao de sua "identidade de doente". No trabalho com pessoas que convivem com doencas cronicas, e de significativa importancia que se leve em consideracao sua historia e vida e a relacao entre a configuracao da identidade e o processo de adoecimento, e que se entenda que mesmo com possiveis modificacoes do quadro clinico da doenca, os processo caracteristicos da identidade podem manter a crenca do individuo de que esses ...

Psicossomatica: um estudo enfocando a psoriase sob a optica psicologica / Psicosomatica: a study focusing on psoriasis under the psychological lens

Este trabalho procurou, atraves de um levantamento literario, investigar numa optica psicologica a psoriase, fundamentado na teoria psicossomatica psicanalitica. Atraves do estudo realizado, verificou-se a importancia de se conhecer os aspectos psicologicos relacionados a dermatose, ja que foram evidenciados fatores emocionais como agente influenciador na etiologia e desenvolvimento da psoriase. Compreendendo assim, que o trabalho podera favorecer na obtencao de dados, que auxiliara profissionais da area da saude a terem uma visao global da dermatose, podendo influenciar de maneira benefica o quadro clinico e qualidade de vida do psoriatico

Psychiatric morbidity in leprosy and psoriasis--a comparative study.

The psychiatric morbidity of 30 leprosy patients was compared with that of psoriasis in a clinic set-up. The prevalence of psychiatric morbidity was significantly less among leprosy patients (122/1000) than among those with psoriasis (476/1000); but the severity of the problem, as measured by General Health Questionnaire (GHQ), was significantly greater among leprosy patients (p < 0.05). There was no difference in the pattern of psychopathology diagnosis between the two groups. Depressive neurosis was the most common diagnosis in both the groups. The relevance of these findings in relation to leprosy is discussed.