The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis.

OBJECTIVE: To evaluate the association between psoriasis (PSO), psoriatic arthritis (PsA) and periodontitis (PE), and the Oral Health-Related Quality of Life (OHRQoL) impacts on individuals with psoriatic disease's daily activities compared to the non-psoriatic ones. MATERIALS & METHODS: 296 individuals with psoriatic disease (PSO n = 210, APS n = 86) (cases) and 359 without these diseases (controls) were included. Complete periodontal examinations and collection of variables of interest were performed. The Brazilian version of the Oral Impacts on Daily Performance (OIDP) instrument was applied. RESULTS: The prevalence of PE was higher in PsA (57.0%; OR = 2.67 95%CI 1.65-4.32; p<0.001) than in PSO (34.3%; OR = 1.05 95% CI 0.73-1.51; p<0.001) compared to controls (33.1%). Both PsA and PSO groups showed more sites and teeth with 4-6mm probing depth (PD) and had higher OIDP scores than controls (p<0.001), thus indicating worse self-reported quality of life. PE, PSO+PE and consumption of alcohol/anxiolytics significantly influenced OHRQoL (p<0.05). The influence of periodontal parameters on OHRQoL was observed for the presence of PE; PD >6 mm; clinical attachment level >6 mm; higher plaque index, % sites and teeth with bleeding on probing (p<0.05). CONCLUSION: Negative impacts of PE on the OHRQoL were demonstrated. The ones having PSO and especially PsA and PE presented significantly worse indicators.

Relato de experiência da atuação da fisioterapia em pacientes com psoríase / Experience report of physiotherapy performance in patients with psoriasis

A psoríase é uma condição dermatológica crônica e inflamatória que se manifesta por pápulas ou placas eritematosas na pele, sendo imunomediada e associada a fatores genéticos, ambientais, sociais e psicológicos. Inserida nas psicodermatoses, sua relação com eventos traumáticos e fatores psicossomáticos. A prevalência no Brasil é de 1,31%, com maior incidência no sexo feminino, relacionada a condições ambientais e predisposição. Foi realizado um relato de experiência da atuação da fisioterapia em um hospital público no interior de São Paulo em pacientes com psoríase, no qual pode associar a Psoriase a finalizações de ciclos ou percas e situações psicossomáticas, onde o individuo passa a se abster de participar de atividades e interações em grupo, o consumo de tabaco pode influenciar o processo de renovação celular, consequentemente o tempo de alta médica, é de grande importância a atuação do fisioterapeuta para as orientações do posicionamento adequado e a realização de exercícios que estimulem e auxiliem a cicatrização e o ganho de ADM. Conclui-se que a abordagem terapêutica deve ser multidisciplinar, portanto, não deve se restringir apenas aos aspectos fisiopatológicos, mas também considerar a dimensão física, psicológica e social

Psoriasis is a chronic and inflammatory dermatological condition that manifests itself as erythematous papules or plaques on the skin, being immune-mediated and associated with genetic, environmental, social and psychological factors. Inserted in psychodermatoses, their relationship with traumatic events and psychosomatic factors. The prevalence in Brazil is 1.31%, with a higher incidence in females, related to environmental conditions and predisposition. An experience report was carried out on the performance of physiotherapy in a public hospital in the interior of São Paulo on patients with psoriasis, which can associate Psoriasis with completion of cycles or losses and psychosomatic situations, where the individual starts to abstain from participating in group activities and interactions, tobacco consumption can influence the cell renewal process, consequently the time of medical discharge. The importance of the physiotherapist's intervention is highlighted, providing guidance on appropriate positioning and implementing exercises that stimulate healing and promote gain in range of motion. It is concluded that the therapeutic approach must be multidisciplinary, therefore, it must not be restricted only to pathophysiological aspects, but also consider the physical, psychological and social dimensions.

Cumulative life course impairment in patients with dermatological diseases, with a focus on psoriasis.

The concept of "Cumulative Life Course Impairment" (CLCI) characterizes the set of factors harmful to the lives of patients resulting from the stigma and physical and psychological impairment associated with different chronic diseases, which can accumulate irreversibly over the course of patients lives. The sum of these factors often makes it impossible for these individuals to enjoy their lives fully, intensely and adequately. On the other hand, CLCI also incorporates coping strategies, including external factors and personality characteristics, which may act as modulating or protective factors of vulnerability to the CLCI. Although psoriasis is the most studied dermatological disease in relation to its impact on quality of life and CLCI, several other chronic inflammatory diseases such as atopic dermatitis, hidradenitis suppurativa, and alopecia areata have also been evaluated in relation to the magnitude of the damage to patients lives.

Quality of life of patients living with psoriasis: a qualitative study.

BACKGROUND: Psoriasis is a multifactorial inflammatory disease prevalent in dermatology. We aimed to understand the perceptions of patients living with psoriasis in relation to their quality of life and to identify aspects to improve it. METHODS: This is qualitative research carried out in a dermatology outpatient clinic of the São Paulo State University (UNESP) medical school, Botucatu, Brazil, with 81 psoriasis patients. The interviews were transcribed and analysed using the Discourse of the Collective Subject method (DCS). RESULTS: Quality of life was linked to well-being, happiness, leisure, good food and financial stability. However, disease symptoms, social and clothing restrictions, impairment of professional activities and the absence of a cure, negatively influenced their perceptions. Suggestions for improvements included an increase of public awareness, stress reduction, disease acceptance and multidisciplinary care. CONCLUSION: The meanings of quality of life revealed by the participants are subjective, multidimensional, linked to moments experienced by them and to the health-disease process. Public health policies promoting reduction in social stigma and stress as well as multidisciplinary approaches towards care can contribute to improvements of QoL in psoriasis.

Psychodermatological mechanisms of psoriasis.

Psoriasis is a chronic disease, mediated by the human immune system, based on a polygenic vulnerability, with cutaneous and systemic manifestations and substantial negative effects on the quality of life of patients. The physical and psychological impacts of psoriasis affect all areas of patient's functioning. Likewise, the prevalence of depression and anxiety in patients with psoriasis is significantly higher than that in the general population, and the quality of life is lower when compared to patients with different dermatological conditions. Both anxiety and depression may increase the clinical severity of psoriasis. Although psychiatric disorders in patients with psoriasis may be secondary to the stress due to the shame and social anxiety related to the skin lesions, the high rate of comorbidity has led to hypothesize that there may be common pathophysiological (psychodermatological) mechanisms involved. Inflammation is a key factor, since alterations in inflammatory modulators such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system have been described. This narrative review of the literature highlights the psychodermatological aspects of the etiopathogenesis of psoriasis as well as the impact of illness on patients' personal identity, functioning, and professional, social, and family areas.

Effectiveness of short-term physical agents treatment on macroscopic morphology in patients with plaque psoriasis / Efectividad del tratamiento a corto plazo de los agentes físicos en la morfología macroscópica de las placas de psoriasis

Psoriasis is a chronic inflammatory disease that presents skin rashes which can arise through plaques. The aim of this work was to compare the effectiveness of short-term physical agents treatment on macroscopic morphology (area and erythema) in patients with plaque psoriasis. This prospective randomized experimental study included fourteen subjects, medically diagnosed with psoriasis, with more than one plaque in the skin and voluntarily without topical treatment. All subjects completed the study that consisted of 12 treatment sessions divided in control (C), artificial balneotherapy (AB), phototherapy (PT) or balneophototherapy (BPT) groups. After session 12, there was a significant reduction of the plaque area by all treatments when compared to C group and BPT was the most effective one. However, only AB and PT presented a reduction of erythema. Regarding severity, 9 patients changed to a lower category on the PASI test, and 5 of them maintained a mild psoriasis, but lowered their score. Finally, 13 of 14 subjects improved their quality of life. The physical agents used reduced the severity of psoriasis and improved quality of life of patients after 12 sessions of treatment during a onemonth period. The BPT was the more effective in controlling psoriasis by diminishing its area and PT by attenuating the erythema.

La Psoriasis es una enfermedad inflamatoria crónica que presenta irritación cutánea que puede derivar a placas. El objetivo de este trabajo fue comparar la efectividad del tratamiento a corto plazo con agentes físicos en la morfología macroscópica (área y eritema) en pacientes con placas de psoriasis. Estudio experimental, prospectivo, randomizado. Catorce sujetos participaron con diagnóstico médico de psoriasis, con más de una placa en la piel y sin tener tratamiento tópico de forma voluntaria. Todos los sujetos completaron el estudio, el cual consistió de 12 sesiones de tratamiento dividido en grupo control (C), BA, FT y BFA. Posterior a la sesión 12, se observó una reducción significativa en toda el área de las placas que recibieron tratamiento al compararlas al grupo C y el grupo BFA fue el más efectivo. Sin embargo, solo los grupos BA y FT presentaron una reducción del eritema. Respecto a la severidad, 9 pacientes cambiaron de la baja categoría en el test de PASI y 5 de ellos se mantuvieron en el nivel medio, pero disminuyeron su puntaje. Finalmente, 13 de 14 sujetos mejoraron su calidad de vida. Los agentes físicos usados redujeron la severidad de la psoriasis y mejoraron la calidad de vida de los pacientes después de 12 sesiones de tratamiento durante el período de un mes. La BFA fue la más efectiva en controlar la psoriasis por la disminución en el área y la FT por la atenuación del eritema.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis

Abstract: Background: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. Objectives: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. Methods: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. Results: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. Study limitations: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. Conclusions: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

Impact of psoriasis in the quality of life of children, adolescents and their families: a cross-sectional study

Abstract: Background: Psoriasis is a chronic and inflammatory disease that impairs quality of life and causes psychological symptoms. Despite the high prevalence of psoriasis in pediatric patients, studies investigating the impact of psoriasis in the quality of life of children, adolescents and families are sparse. Objective: To investigate the impact of psoriasis in the quality of life of children and adolescents with psoriasis and their families and to determine depression and anxiety levels of the patients. Methods: A total of 58 patients with psoriasis aged 7-18 years (median age: 11) and a family member of each patient were included in the study. Children's Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), Children's Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIC) were used in the study. Results: The median PASI score of the patients included in the study was 1.8. The median CDLQI and FDLQI scores in the study groups were 5 and 10, respectively. The median CDI score, STAIC-state and STAIC-trait scores of the patients were 6, 28 and 32.5, respectively. Study limitations: Lack of a control group and patient assessment of disease severity. Relatively mild disease severity of the subjects. Conclusions: Psoriasis has a negative impact in the quality of life of children, adolescents and their families, even in the presence of mild disease. Considering that impairment in quality of life may be associated with psychosocial morbidity, a combined approach with medical therapy, family counseling and quality of life assessment may be beneficial in this patient group.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis.

BACKGROUND: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. OBJECTIVES: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. METHODS: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. RESULTS: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. STUDY LIMITATIONS: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. CONCLUSIONS: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

Impact of psoriasis in the quality of life of children, adolescents and their families: a cross-sectional study.

BACKGROUND: Psoriasis is a chronic and inflammatory disease that impairs quality of life and causes psychological symptoms. Despite the high prevalence of psoriasis in pediatric patients, studies investigating the impact of psoriasis in the quality of life of children, adolescents and families are sparse. OBJECTIVE: To investigate the impact of psoriasis in the quality of life of children and adolescents with psoriasis and their families and to determine depression and anxiety levels of the patients. METHODS: A total of 58 patients with psoriasis aged 7-18 years (median age: 11) and a family member of each patient were included in the study. Children's Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), Children's Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIC) were used in the study. RESULTS: The median PASI score of the patients included in the study was 1.8. The median CDLQI and FDLQI scores in the study groups were 5 and 10, respectively. The median CDI score, STAIC-state and STAIC-trait scores of the patients were 6, 28 and 32.5, respectively. STUDY LIMITATIONS: Lack of a control group and patient assessment of disease severity. Relatively mild disease severity of the subjects. CONCLUSIONS: Psoriasis has a negative impact in the quality of life of children, adolescents and their families, even in the presence of mild disease. Considering that impairment in quality of life may be associated with psychosocial morbidity, a combined approach with medical therapy, family counseling and quality of life assessment may be beneficial in this patient group.

The association between psoriasis and health-related quality of life, work productivity, and healthcare resource use in Brazil.

BACKGROUND: Psoriasis is a chronic, immune mediated inflammatory condition that affects a significant amount of the global population. Yet geographic variability in the consequences of psoriasis warrants region-level analyses. OBJECTIVE: The current study contributes to the psoriasis outcomes literature by offering a comprehensive assessment of the humanistic and economic burden in Brazil. METHODS: The 2012 Brazil National Health and Wellness Survey (N=12,000) was used to assess health-related quality of life (Short Form-12, version 2), work productivity, and healthcare resource use associated with experiencing psoriasis vs. no psoriasis, along with varying levels of psoriasis severity. RESULTS: A total of 210 respondents reported diagnosis of psoriasis (N=157, 42, and 11 reporting mild, moderate, and severe psoriasis, respectively). Compared with controls, respondents with psoriasis reported diminished mental component summary scores and health utilities, as well as increased presenteeism, activity impairment, and physician visits over the past six months, adjusting for covariates. Among those with psoriasis, physical health decreased as psoriasis severity increased. Although work productivity and healthcare resource utilization did not differ with psoriasis severity, the high rates of productivity loss (e.g. 45.5% presenteeism in the severe psoriasis group) suggest an economic burden. STUDY LIMITATIONS: Cost analyses were not performed, and cross-sectional patient-reported data limit causal conclusions and may reflect reporting biases. CONCLUSIONS: Nevertheless, these results suggest a significant burden to patients with psoriasis across both humanistic and economic outcomes. The association between psoriasis and mental health aspects and health utilities were particularly strong and exceeded what would be considered clinically meaningful.

Assessment of psoriasis severity in Brazilian patients with chronic plaque psoriasis attending outpatient clinics: a multicenter, population-based cross-sectional study (APPISOT).

PURPOSE: Data on chronic plaque psoriasis severity and its potential clinical and lifestyle implications in the Brazilian population are limited. The primary aim of this study was to assess the clinical severity of plaque psoriasis in Brazil. Further objectives included evaluating potential associations between disease severity and demographic, lifestyle, and clinical characteristics, health-related quality of life (HRQOL), and work productivity. MATERIALS AND METHODS: This observational (non-interventional) cross-sectional study was conducted in 26 dermatologic clinics across 11 Brazilian states. Psoriasis severity was assessed using investigator judgment and Finlay's Rule of Tens: a Psoriasis Area and Severity Index (PASI) score >10, a Body Surface Area (BSA) > 10%, or a Dermatology Life Quality Index (DLQI) score >10. RESULTS: Among 1125 patients, 205 (18.2%) had moderate-to-severe disease. On multiple regression analyses, psoriasis severity was significantly (directly) associated with the presence of physical inactivity and comorbid pain, anxiety, and depression; and significantly (inversely) associated with HRQOL and work productivity. LIMITATIONS: Cross-sectional studies cannot assess temporal trends, and observational studies cannot conclusively determine causality or exclude biases and confounding due to unmeasured variables. CONCLUSIONS: Among Brazilian patients with moderate-to-severe psoriasis, disease severity had far-reaching adverse impacts on lifestyle, comorbidities, HRQOL, and work productivity.

The association between psoriasis and health-related quality of life, work productivity, and healthcare resource use in Brazil

Abstract: Background: Psoriasis is a chronic, immune mediated inflammatory condition that affects a significant amount of the global population. Yet geographic variability in the consequences of psoriasis warrants region-level analyses. Objective: The current study contributes to the psoriasis outcomes literature by offering a comprehensive assessment of the humanistic and economic burden in Brazil. Methods: The 2012 Brazil National Health and Wellness Survey (N=12,000) was used to assess health-related quality of life (Short Form-12, version 2), work productivity, and healthcare resource use associated with experiencing psoriasis vs. no psoriasis, along with varying levels of psoriasis severity. Results: A total of 210 respondents reported diagnosis of psoriasis (N=157, 42, and 11 reporting mild, moderate, and severe psoriasis, respectively). Compared with controls, respondents with psoriasis reported diminished mental component summary scores and health utilities, as well as increased presenteeism, activity impairment, and physician visits over the past six months, adjusting for covariates. Among those with psoriasis, physical health decreased as psoriasis severity increased. Although work productivity and healthcare resource utilization did not differ with psoriasis severity, the high rates of productivity loss (e.g. 45.5% presenteeism in the severe psoriasis group) suggest an economic burden. Study limitations: Cost analyses were not performed, and cross-sectional patient-reported data limit causal conclusions and may reflect reporting biases. Conclusions: Nevertheless, these results suggest a significant burden to patients with psoriasis across both humanistic and economic outcomes. The association between psoriasis and mental health aspects and health utilities were particularly strong and exceeded what would be considered clinically meaningful.

Psychopathology and alexithymia in patients with psoriasis.

BACKGROUND:: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. OBJECTIVE:: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. METHODS:: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. RESULTS:: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. STUDY LIMITATIONS:: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. CONCLUSIONS:: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis.

The relationship between pruritus and clinical variables in patients with psoriasis.

BACKGROUND:: Pruritus is the most commonly occurring subjective symptom of dermatological disease. Published data on both prevalence and intensity of pruritus in psoriasis is limited. OBJECTIVE:: In this study we aimed to investigate the prevalence of pruritus and its relation with psoriasis area severity index, body mass index and presence of systemic disease in patients with psoriasis. METHODS:: We analyzed data of psoriatic patients diagnosed in our psoriasis outpatient clinic between March 2013 and June 2014 collected retrospectively from PSR-TR registration system. RESULTS:: In total, 880 patients were analyzed. Pruritus was more prominent in female patients. This difference was statistically significant. No significant associations were found between age of patients, clinical type of disease and pruritus. The itching was more common in patients with higher body mass index. Presence of pruritus was correlated significantly with severity of psoriasis. Five hundred and sixty of 880 patients had no systemic disease. The presence of pruritus was not related with presence of systemic disease. Existence of systemic disease with psoriasis has minimal effect on pruritus. STUDY LIMITATIONS:: We did not evaluate intensity of pruritus. CONCLUSIONS:: Pruritus is not mentioned within the classical symptoms of psoriasis. Pruritus in psoriasis is a very unpleasant symptom with great potential to impair patient's quality of life and may exacerbate psoriasis as a Koebner phenomenon.

Psychopathology and alexithymia in patients with psoriasis

Abstract: Background: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. Objective: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. Methods: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. Results: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. Study Limitations: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. Conclusions: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis.

The relationship between pruritus and clinical variables in patients with psoriasis

Abstract: Background: Pruritus is the most commonly occurring subjective symptom of dermatological disease. Published data on both prevalence and intensity of pruritus in psoriasis is limited. Objective: In this study we aimed to investigate the prevalence of pruritus and its relation with psoriasis area severity index, body mass index and presence of systemic disease in patients with psoriasis. Methods: We analyzed data of psoriatic patients diagnosed in our psoriasis outpatient clinic between March 2013 and June 2014 collected retrospectively from PSR-TR registration system. Results: In total, 880 patients were analyzed. Pruritus was more prominent in female patients. This difference was statistically significant. No significant associations were found between age of patients, clinical type of disease and pruritus. The itching was more common in patients with higher body mass index. Presence of pruritus was correlated significantly with severity of psoriasis. Five hundred and sixty of 880 patients had no systemic disease. The presence of pruritus was not related with presence of systemic disease. Existence of systemic disease with psoriasis has minimal effect on pruritus. Study Limitations: We did not evaluate intensity of pruritus. Conclusions: Pruritus is not mentioned within the classical symptoms of psoriasis. Pruritus in psoriasis is a very unpleasant symptom with great potential to impair patient's quality of life and may exacerbate psoriasis as a Koebner phenomenon.

Estudio de la proxémica, el contacto y la expresión de las emociones en una muestra de pacientes con psoriasis / Study of proxemics, contact and emotional expression in a psoriasis patients' sample

Antecedentes: la relación entre alexitimia y psoriasis es compleja y está vinculada con procesos de separación-individuación y con problemáticas en el desarrollo de un apego seguro para establecer relaciones de confianza y regular las emociones y el estrés. Objetivos: analizar la proxémica, el contacto y la expresión emocional de los pacientes con psoriasis en los vínculos materno-filiales y del área sexual. Método: en un estudio correlacional a 51 personas con psoriasis y 56 controles se les aplicaron diferentes instrumentos para evaluar Alexitimia, Apego y Proxémica. Resultados: las personas con psoriasis demostraron mayor evitación del contacto en la sexualidad. La evitación del contacto fue superior al conjugarse la presencia de alexitimia y de psoriasis. Conclusiones: las personas con psoriasis tendrían un menor contacto en la sexualidad y más respuestas fusionales o de lejanía en la relación niño-madre sugiriendo problemáticas de apego. Los resultados obtenidos con los instrumentos administrados sugieren que la alexitimia podría afectar la sexualidad y se potenciaría con la psoriasis generando dificultades de contacto.

Background: the relationship between alexithymia and psoriasis is complex and is related to separation-individualization processes and to difficulties in the development of a secure attachment to establish trustful relationships and to regulate emotions and stress. Objectives: to analyze psoriasis subjective factors such us proxemics, contact and emotional expression on people with psoriasis on their mother-child and sexual bonds. Method: in a correlational study, different scales were applied to 51 psoriasis patients and 56 controls to evaluate Alexithymia, Attachment and Proxemics. Results: people with psoriaris showed more contact avoidance in the sexuality area. Avoidance of contact was greater when alexithymia and psoriasis appeared together. Conclusions: people with psoriasis could have less sexual contact and greater fusional or distance responses on the son-mother bond suggesting difficulties in attachment. Alexithymia could affect sexuality and it could maximize its effects when combined with psoriasis producing contact difficulties.

Stress level of people with psoriasis at a public hospital.

BACKGROUND: Psoriasis is a chronic dermatosis of unknown etiology with a tendency to relapse after treatment. The disease is frequently linked to psychological stress due to the embarrassment caused by the lesions. OBJECTIVE: To analyze the stress level presented by psoriasis patients followed at the Dermatology Service of a public hospital in Salvador, Bahia state, Brazil. METHODS: A cross-sectional study of a consecutive convenience sample composed of 60 participants. We used Lipp's Stress Symptoms Inventory for Adults to assess stress levels. The questionnaire identifies and classifies physical and psychological symptoms according to three stages of stress: alarming, resistance, and exhaustion. We also collected socio-demographic and clinical data that could be associated with psoriasis. RESULTS: 85% of the participants presented stress. Lipp's questionnaire results revealed that 48% were in the resistance stage and 37% in the exhaustion stage. Women presented higher levels of stress. Of the total 28 women, 64% were in exhaustion stage, 29% in the resistance stage, and only 7% presented no stress symptoms. Of the total 32 men, 44% were in resistance stage, 34% in exhaustion stage, and 22% presented no stress symptoms. Regarding physical and psychological symptoms, psychological symptomatology was prevalent (55%). CONCLUSIONS: Based on the number of patients in exhaustion stage, we can conclude that stress levels of the participants were high regardless the type of psoriasis and treatment duration.