Publications

Objectives While stress plays a paramount role on the onset/exacerbation of psoriasis, via overactivation of the hypothalamic–pituitary–adrenal axis and increased release of pro-inflammatory cytokines, cutaneous inflammatory response induces, in turn, anxiety/depression symptoms, via body disfigurement and stigmatisation. The intensity of pruritus and anogenital involvement are additional risk factors for psychological comorbidity.Aims were to (1) examine the effects of intensity of pruritus and anogenital psoriasis on disease burden and psychological comorbidity and (2) identify the variables associated with the presence of clinically significant depression, anxiety, and dysmorphic concerns.

Design Cross-sectional study.

Setting Conducted at the University Medical Center Hamburg-Eppendorf (UKE).

Participants 107 patients with psoriasis (mean age = 46.3, SD = 14.6 years; 53.3% male): 64 with none/mild pruritus; 43 with moderate/severe pruritus; 31 with anogenital psoriasis; 76 not affected in the anogenital area.

Primary/secondary outcomes measures Disease severity was assessed with Psoriasis Area and Severity Index and intensity of pruritus was rated by patients. Patient-reported outcomes included the Dermatology Life Quality Index, ItchyQoL, Patient Benefit Index, Perceived Stigmatisation Questionnaire, and Relationship and Sexuality Scale. Psychological morbidity was assessed with the Patient Health Questionnaire, Generalised Anxiety Disorder, and Dysmorphic Concern Questionnaire.

Results Patients with moderate/severe pruritus reported more quality of life impairments, depression, anxiety and dysmorphic concerns, and less treatment benefits than those with none/mild pruritus. Moderate/severe pruritus had a deleterious effect on depression and stigmatisation for patients without anogenital involvement. Less patient benefits were associated with a higher likelihood of clinically significant depression/anxiety.

Conclusion Pruritus induces significant burden and psychological morbidity, particularly for patients without anogenital involvement. However, coping strategies used by patients with anogenital psoriasis might be dysfunctional for overall psychosocial adaptation. Patient-centred healthcare might be the best way to prevent psychological comorbidity.

According to the definition of the World Health Organization, health is not only understood as the absence of disease, but also as the restoration of full physical, mental and social well-being. Therefore, in the management of psoriatic disease, well-being should be included as an important endpoint. So far, primarily burden-focused patient-reported outcome instruments such as the Dermatology Life Quality Index (DLQI) are used in practice and research, many showing marked limitations. Thus, the aim of this study was to test the psychometric properties of the generic WHO-5 questionnaire for the assessment of well-being in people with psoriasis.

The people-centred model of care for psoriasis emphasizes the importance of prioritizing patient’s needs and preferences in clinical decisions, along with physician-rated disease severity. However, patients and physicians often differ on their perceptions of disease severity, which might influence treatment adherence/satisfaction and health outcomes. This study aimed at understanding the extent and direction of patient–physician (dis)agreement on their reports of body surface area (BSA) affected by psoriasis and exploring which patient-reported outcomes (PROs) might contribute to explain the disagreement.

This study aimed to examine the health-related quality of life (HrQoL), coping, height-related beliefs, and social support of children/adolescents with short stature, the sociodemographic, clinical, and psychosocial variables associated with HrQoL, and the moderating role of sociodemographic and clinical variables on the associations between psychosocial variables and HrQoL.

Poster preseted at the Society of Behavioral Medicine, Baltimore, MD.

J Vasc Surg Venous Lymphat Disord. 2022 Jan;10(1):139-145.e1

Chronic venous disease is a frequent vascular condition. International societies have recommended the use of health-related quality of life (HRQoL) instruments in the assessment of patients with vascular diseases. Thus, the Freiburg Life Quality Assessment for chronic venous disease, 10-item questionnaire (FLQA-VS-10) was developed. The aim of the present study was to validate the FLQA-VS-10 in a prospective study.

Br J Dermatol. 2022 Jan 22. doi: 10.1111/bjd.21029

The quality of dermatology consultations is partly determined by how clinicians approach patient care. The term ‘Personal Models’ describes the explanatory frameworks of thoughts, feelings and experiences that drive behaviour. One study found that clinicians’ personal models, specifically their beliefs about autonomy and patient self-management, influenced the degree to which clinicians engage patients in shared decision-making during consultations. Further research is needed to further explore how clinicians’ personal models inform and affect the quality of patient care.