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Journal of Dermatology & Dermatologic Surgery xxx (2015) xxxxxx

Original article

Psoriasis: Correlation between severity index (PASI) and quality


of life index (DLQI) based on the type of treatment
Ali Al Raddadi a, Abdulhadi Jfri b,, Sahal Samarghandi a, Nesreen Matury a, Taha Habibullah a,
Majed Alfarshoti c, Ahmad Mahdi a
a
King Abdulaziz Medical City, Jeddah, Saudi Arabia
b
King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
c
National Guard Hospital, Al Hassa, Saudi Arabia

Received 3 April 2015; accepted 22 May 2015

Abstract

Background: Psoriasis vulgaris is a common chronic dermatological disease that has a negative impact on the psychological status and
the social interaction of the patient.
Objective: To correlate the quality of life and clinical severity of psoriasis vulgaris in patients using dierent types of treatment.
Materials and methods: This is a prospective observational cross-sectional study that took place over a 4 month period, from January
to April 2014, at the King Abdul Aziz Medical City, Jeddah, Saudi Arabia. All patients with psoriasis vulgaris attending the dermatology
clinics during this period were included.
Results: Of the total 41 Saudi patients, 25 were males and 16 were females. 21 were on combined (i.e. topical with either systemic or
NB-UVB) and 20 were on topical treatments only. PASI score was moderate in the majority for both groups, that is, patients on topical
(70%) and combined treatment (80%). DLQI score shows only a small eect on the patients quality of life for the majority (14/20) in the
topical group and (16/21) for those on combined therapy.
Conclusion: There is no signicant dierence in terms of the eect of the type of treatment between the two groups.
2015 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Psoriasis vulgaris; Dermatology life quality index (DLQI); Psoriasis area and severity index (PASI)

1. Introduction (Grob and Folchetti, 1999; Koo, 1996; da Silva et al.,


2013). Classic psoriasis vulgaris usually appears in specic
Psoriasis is a relatively common, chronic condition areas including the elbows, knees and scalp. Although nei-
aecting between 1% and 3% of the general population ther life threatening nor contagious, psoriasis causes mea-
surable harm to patients health-related quality of life
Corresponding author at: King Saud bin Abdulaziz University for
(HRQoL) through the psychological and social conse-
Health Sciences, Internal Mail 6556, P.O. Box 9515, Jeddah 21423, Saudi
quences of having plaques on the skin (Ramsay and
Arabia. Tel.: +966 2 2245848; fax: +966 920008668x26243. OReagan, 1988).
E-mail address: Abdulhadijfri@gmail.com (A. Jfri). Generally, a diagnosis of psoriasis is informed by exam-
Peer review under responsibility of King Saud University. ination of the skin. The classic symptoms of psoriasis vul-
garis are highly visible chronic erythematous plaques
covered by silvery white scales, forming on the elbows,
Production and hosting by Elsevier knees, scalp, umbilicus and lumbar area (Schon and

http://dx.doi.org/10.1016/j.jdds.2015.05.002
2352-2410/ 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002
2 A.A. Raddadi et al. / Journal of Dermatology & Dermatologic Surgery xxx (2015) xxxxxx

Boehncke, 2005). The Dermatology quality of life index Arabic version of dermatology life quality index (DLQI)
(DLQI) is a10-item survey evaluating the quality of life was administered to the patients and an assessment of the
in patients with a skin disease, covering six domains: symp- disease was carried out by using the psoriasis area severity
toms and feelings, daily activities, leisure, work and school, index (PASI). Patient data were documented on a special
Personal Relationships and treatment (Finlay and Khan, form, including gender, age, BMI, smoking status and
1994). DLQI has-been found highly sensitive to improve- detailed information about the type of treatment, dose, fre-
ments in psoriasis symptoms and shows a positive correla- quency and duration of treatment. The study was approved
tion with the psoriasis area severity index (PASI) (Basra by King Abdullah International Medical Research Center
et al., 2008; Revicki et al., 2008). There are relatively few (KAIMRC), protocol number is RJ13/033/J.
studies in the literature examining the correlation between The collecting data sheets of all patients visiting the der-
quality of life and symptom severity in patients with psori- matology clinics during the study period were reviewed. No
asis (da Silva et al., 2013). inclusion or exclusion criteria were applied. A total of 41
One study discusses the relationship between quality of papers were entered into the system. Data analysis was car-
life and skin clearance in moderate-to-severe psoriasis ried out using SPSS v16.0 and descriptive statistics were
patients treated with iniximab (Reich and Griths, used to analyze the patients data.
2008). In Saudi Arabia, a study was done to evaluate the
quality of life in patients with psoriasis vulgaris before
and after phototherapy. This study concluded that narrow 4. Results
band ultraviolet B (NB-UVB) photo therapy can improve
the quality of life in patients with psoriasis vulgaris (Al A total of 41 patients with psoriasis vulgaris visited the
Robaee and Alzolibani, 2011). To the best of our knowl- Dermatology clinic from January 2014 to April 2014. Of
edge, no prior study in our area compares quality of life these, 4 were newly diagnosed and 37 were known cases
and clinical severity in patients using topical treatment coming in for follow-up. Of the 41 patients, 25 were males
alone for psoriasis vulgaris with quality of life and clinical and 16 were females, and all the patients were Saudi
severity in patients on combined treatment (that is, topical nationals. The majority of the patients had been diagnosed
treatment combined with either phototherapy or systemic) with psoriasis more than 10 years ago (23; 56.1%). Most of
to nd out if there is any correlation. those (31.71%) were having severe PASI score. Of the 41
patients, 21 were on combined treatment (topical with
either systemic or NB-UVB) and 20 were on topical treat-
2. Purpose of the study ment only. The majority (11 out of 21 patients; 52.4%) of
those on combined treatment were on oral Methotrexate
To evaluate the quality of life and clinical severity of with folic acid and topical calcipotriol with betamethasone
psoriasis vulgaris in patients on topical and combined dipropionate ointment. The majority (17 out of 20 patients;
treatment and compare the dierences between the two 85%) of those on topical treatment were only on topical
groups based on the type of the treatment. calcipotriol with betamethasone dipropionate ointment.
PASI score was moderate in the majority of patients in
3. Methods and materials both groups, topical (14/20; 70%) and combined treatment
(17/21; 81%) (Table 1). Of the 41 patients, 17 (41.5%) had
A cross sectional survey was conducted between January nail changes in form of pitting and 9 (22%) had an estab-
1st and April 30th, 2014 enrolling patients with psoriasis lished diagnosis of psoriatic arthritis. The majority, 23
vulgaris attending the Dermatology clinic at the King (56.1%), were obese and most of them (24.39%) had mild
Abdul Aziz medical city (KAMC). The (KAMC) PASI score. 19.5% were smokers in the study and the
National Guard Hospital is a 540-bed referral healthcare majority of them 4 out of 8 (50%) were having severed
facility and teaching hospital. It is located in Jeddah and PASI score (Table 2). DLQI score shows only a small eect
serves all National Guard soldiers, employees and on the patients quality of life for the majority (14/20) of
dependents, as well as eligible patients in the western region patients in the topical group and a moderate eect on the
of Saudi Arabia. Data were collected from the patients by patients quality of life for those on combined (16/21;
dermatologists. A 10 item questionnaire using the veried 76.2%) (Table 3).

Table 1
PASI score based on the type of the treatment.
PASI score result Topical treatment Combined treatment Total Percentage (%)
Males Females Total Males Females Total
Mild (110) 2 2 4 2 1 3 7 17.07
Moderate (1020) 6 8 14 10 7 17 31 75.61
Severe (>20) 1 1 2 1 0 1 3 7.32
Total 9 11 20 13 8 21 41 100.00

Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002
A.A. Raddadi et al. / Journal of Dermatology & Dermatologic Surgery xxx (2015) xxxxxx 3

Table 2
PASI score with Chronicity, body mass index (BMI) and smoking status.
PASI score result Chronicity BMI Smokers
<5 years 510 years >10 years Normal (1824) Over-weight (2530) Obese (>30)
Mild (110) 2 1 4 5 4 10 3
Moderate (1020) 3 3 6 3 0 6 1
Severe (>20) 4 5 13 2 4 7 4
Total 9 9 23 10 8 23 8

Table 3
DLQI score based on the type of the treatment.
DLQI score Topical treatment Combined treatment Total Percentage (%)
Males Females Total Males Females Total
No eect at all on patients life 2 1 3 2 0 2 5 12.20
Small eect on patients life 7 7 14 9 7 16 30 73.17
Moderate eect on patients life 0 2 2 1 1 2 4 9.76
Very large eect on patients life 0 1 1 1 0 1 2 4.88
Total 9 11 20 13 8 21 41 100.00

5. Discussion Conict of interest

The present study has produced evidence that psoriasis The author has no conicts of interest that are directly
has a meaningful negative impact on a patients QOL. relevant to the content of this study. No sources of funding
These results are consistent with previous researches on were used to assist in preparation of this manuscript.
psoriasis vulgaris (Choi and Koo, 2003; Fortune et al.,
1997; Finlay and Coles, 1995; Feldman et al., 1997). The References
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Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002
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Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002