Health-Related Quality of Life in Patients with Psoriasis. Associations with the Illness Severity, Personality Patterns and Psychiatric Symptoms

Introduction: Psoriasis is a chronic inflammatory skin disorder with a complex immune- mediated pathophysiology affecting between 0.91% and 8.5% of the general population. Various psychopathological conditions are associated with psoriasis, and they either result from or contribute to psoriasis. Several studies have reported lower quality of life in subjects with psoriasis plus psychiatric presentations compared to patients with psoriasis alone. Objective: This study was intended to evaluate the quality of life of patients with psoriasis related to illness severity, psychiatric symptoms and personality patterns. Notably, no research has examined the relationship between quality of life and personality patterns using clinician perspective. Materials and methods: The study is based on a multi-method and multi-informant design. Eighty patients, 40 assigned to biologic therapy and 40 to topical therapy, were evaluated with self-report measures, such as the Symptom Checklist-90-R (SCL-90R) and Psoriasis Index of Quality of Life (PSORIQoL). Patients’ personality and psychological functioning were also evaluated by external raters using the Shedler-Westen Assessment Procedure (SWAP-200) (based on the Clinical Diagnostic Interview; CDI). Finally, the severity and areas of their psoriatic lesions were evaluated with the Psoriasis Area Severity Index (PASI). Results: Significant differences between groups (biologic vs topical therapy) were found in PASI scores: patients assigned to biological therapy have shown lower levels of illness severity. Nevertheless, no differences between groups were found in PSORIQoL scores. The quality of life was negatively associated with various dimensions of SCL-90R, as well as with borderline and dependent personality styles/disorders; on the contrary, it did not relate to PASI. Conclusions: Effectiveness of medical treatment may not have a direct effect on life satisfaction and well-being. Indeed, results seem to suggest that the quality of life in psoriatic patients is more influenced by personality characteristics and psychiatric symptoms than by the severity of psoriatic lesions.