Skip to main content

Advertisement

SpringerLink
Log in

The impact of complete clearance and almost complete clearance of psoriasis on quality of life: a literature review

  • Review
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Background

Psoriasis is a chronic skin condition with systemic manifestations that have a detrimental impact on a patient’s quality of life, affecting social, psychological, and sexual aspects of life. Complete clearance of lesions is a meaningful end goal of treatment; however, it is often difficult for patients to achieve. In this literature review, we summarized past studies that compared patients who achieved complete clearance to those who were almost clear to highlight the effect of complete clearance on psychological distress, social stigma, self-esteem, and interpersonal relationships in adult patients with psoriasis.

Methods

A literature search was performed through the PubMed database using the keywords “clearance of psoriasis”, “complete clearance of psoriasis”, “psychological impact psoriasis”, “social impact psoriasis”, and “stigma of psoriasis”. Age (< 18) and language (only articles written in English were included) were the only exclusion criteria to include adult patients only. The information was then collected and evaluated to compare complete clearance and almost complete clearance of psoriasis.

Results

Of the patients with complete skin clearance (sPGA of 0), 61.4–91.1% reported a Dermatology Life Quality Index (DLQI) of 0, indicating no detectable impact of psoriasis on quality of life, compared to 45.7–48.3% who were almost clear. Patients who were completely clear felt psoriasis had less of an effect on their leisure activities and daily living compared to patients who were almost clear. Patient perceptions of disease severity also differed between the two groups, with the majority (65.5%) of those achieving complete clearance reporting a Psoriasis Symptom Inventory (PSI) of 0, which is consistent with their disease being “not at all severe”, compared to 32.6% of those who were almost but not completely clear. While patients with complete clearance achieve a DLQI of 0 at a higher rate than those who have only almost complete clearance, the difference in the mean DLQI between patients with sPGA of 0 (completely clear) and sPGA of 1 (almost clear) is less than the minimal clinically important difference (MCID of 3–5) of the DLQI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blauvelt A, Wu JJ, Armstrong A, Menter A, Liu C, Jacobson A (2020) Importance of complete skin clearance in psoriasis as a treatment goal: implications for patient-reported outcomes. J Drugs Dermatol 19(5):487–492

    Article  PubMed  Google Scholar 

  2. Aghaei S, Moradi A, Ardekani GS (2009) Impact of psoriasis on quality of life in Iran. Indian J Dermatol Venereol Leprol 75(2):220. https://doi.org/10.4103/0378-6323.48689

    Article  PubMed  Google Scholar 

  3. Feldman SR, Malakouti M, Koo JY (2014) Social impact of the burden of psoriasis: effects on patients and practice. Dermatol Online J 20(8):13030/qt48r4w8h2

    Article  PubMed  Google Scholar 

  4. Strober B, Papp KA, Lebwohl M et al (2016) Clinical meaningfulness of complete skin clearance in psoriasis. J Am Acad Dermatol 75(1):77–82. https://doi.org/10.1016/j.jaad.2016.03.026

    Article  PubMed  Google Scholar 

  5. Norris D, Photiou L, Tacey M et al (2017) Biologics and dermatology life quality index (DLQI) in the Australasian psoriasis population. J Dermatol Treat 28(8):731–736. https://doi.org/10.1080/09546634.2017.1329501

    Article  Google Scholar 

  6. Karamata VV, Gandhi AM, Patel PP, Sutaria A, Desai MK (2017) A study of the use of drugs in patients suffering from psoriasis and their impact on quality of life. Indian J Pharmacol 49(1):84–88. https://doi.org/10.4103/ijp.IJP_166_16

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rasmussen MK, Enger M, Dahlborn AK et al (2019) The importance of achieving clear or almost clear skin for patients: results from the Nordic countries of the global. Acta Derm Venereol 99(2):158–163. https://doi.org/10.2340/00015555-3048

    Article  PubMed  Google Scholar 

  8. Korman NJ, Malatestinic W, Goldblum OM et al (2020) Assessment of the benefit of achieving complete versus almost complete skin clearance in psoriasis: a patient’s perspective. J Dermatol Treat. https://doi.org/10.1080/09546634.2020.1772454

    Article  Google Scholar 

  9. Al-Suwaidan SN, Feldman SR (2000) Clearance is not a realistic expectation of psoriasis treatment. J Am Acad Dermatol 42(5 Pt 1):796–802. https://doi.org/10.1067/mjd.2000.103983

    Article  CAS  PubMed  Google Scholar 

  10. Feldman SR, Bushnell DM, Klekotka PA et al (2016) Differences in psoriasis signs and symptom severity between patients with clear and almost clear skin in clinical practice. J Dermatol Treat 27(3):224–227. https://doi.org/10.3109/09546634.2015.1093589

    Article  Google Scholar 

  11. Viswanathan HN, Chau D, Milmont CE et al (2015) Total skin clearance results in improvements in health-related quality of life and reduced symptom severity among patients with moderate to severe psoriasis. J Dermatol Treat 26(3):235–239. https://doi.org/10.3109/09546634.2014.943687

    Article  Google Scholar 

  12. Takeshita J, Callis Duffin K, Shin DB et al (2014) Patient-reported outcomes for psoriasis patients with clear versus almost clear skin in the clinical setting. J Am Acad Dermatol 71(4):633–641. https://doi.org/10.1016/j.jaad.2014.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  13. Basra MK, Salek MS, Camilleri L, Sturkey R, Finlay AY (2015) Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data. Dermatology 230(1):27–33. https://doi.org/10.1159/000365390

    Article  CAS  PubMed  Google Scholar 

  14. Reich K, Griffiths CE (2008) The relationship between quality of life and skin clearance in moderate-to-severe psoriasis: lessons learnt from clinical trials with infliximab. Arch Dermatol Res 300(10):537–544. https://doi.org/10.1007/s00403-008-0885-7

    Article  CAS  PubMed  Google Scholar 

  15. Egeberg A, Thyssen JP (2019) Factors associated with patient-reported importance of skin clearance among adults with psoriasis and atopic dermatitis. J Am Acad Dermatol 81(4):943–949. https://doi.org/10.1016/j.jaad.2019.06.018

    Article  PubMed  Google Scholar 

  16. Kouwenhoven TA, van der Ploeg JAM, van de Kerkhof PCM (2020) Treatment goals in psoriasis from a patient perspective: a qualitative study. J Dermatol Treat 31(1):13–17. https://doi.org/10.1080/09546634.2018.1544408

    Article  Google Scholar 

  17. Armstrong A, Jarvis S, Boehncke WH et al (2018) Patient perceptions of clear/almost clear skin in moderate-to-severe plaque psoriasis: results of the Clear About Psoriasis worldwide survey. J Eur Acad Dermatol Venereol 32(12):2200–2207. https://doi.org/10.1111/jdv.15065

    Article  CAS  PubMed  Google Scholar 

  18. Ogbechie-Godec O, Azarchi S, Lee J, Cohen DE, Neimann A, Nagler AR (2019) Validated patient-reported outcome measurements for psoriasis may not reflect patients’ current preferences. J Am Acad Dermatol 80(5):1445–1447. https://doi.org/10.1016/j.jaad.2018.09.019

    Article  PubMed  Google Scholar 

  19. Kauf TL, Yang JC, Kimball AB et al (2015) Psoriasis patients’ willingness to accept side-effect risks for improved treatment efficacy. J Dermatol Treat 26(6):507–513. https://doi.org/10.3109/09546634.2015.1034071

    Article  Google Scholar 

  20. Hawro M, Maurer M, Weller K et al (2017) Lesions on the back of hands and female gender predispose to stigmatization in patients with psoriasis. J Am Acad Dermatol 76(4):648–54.e2. https://doi.org/10.1016/j.jaad.2016.10.040

    Article  PubMed  Google Scholar 

  21. Sampogna F, Tabolli S, Abeni D (2007) The impact of changes in clinical severity on psychiatric morbidity in patients with psoriasis: a follow-up study. Br J Dermatol 157(3):508–513. https://doi.org/10.1111/j.1365-2133.2007.08071.x

    Article  CAS  PubMed  Google Scholar 

  22. Böhm D, Stock Gissendanner S, Bangemann K et al (2013) Perceived relationships between severity of psoriasis symptoms, gender, stigmatization and quality of life. J Eur Acad Dermatol Venereol 27(2):220–226. https://doi.org/10.1111/j.1468-3083.2012.04451.x

    Article  PubMed  Google Scholar 

  23. Kamata M, Tada Y (2020) Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review. Int J Mol Sci. https://doi.org/10.3390/ijms21051690

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fairchild AO, Reed SD, Johnson FR, Anglin G, Wolka AM, Noel RA (2017) What is clearance worth? Patients’ stated risk tolerance for psoriasis treatments. J Dermatol Treat 28(8):709–715. https://doi.org/10.1080/09546634.2017.1329499

    Article  Google Scholar 

  25. Elewski BE, Puig L, Mordin M et al (2017) Psoriasis patients with psoriasis Area and Severity Index (PASI) 90 response achieve greater health-related quality-of-life improvements than those with PASI 75–89 response: results from two phase 3 studies of secukinumab. J Dermatol Treat 28(6):492–499. https://doi.org/10.1080/09546634.2017.1294727

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, 27157-1071, USA

    Nicole D. Boswell, Madison K. Cook, Esther A. Balogh & Steven R. Feldman

  2. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

  3. Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

  4. Department of Dermatology, University of Southern Denmark, Odense, Denmark

    Steven R. Feldman

Authors
  1. Nicole D. Boswell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Madison K. Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esther A. Balogh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven R. Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NB wrote the main manuscript text and EB, MC, and SF contributed by editing the manuscript. MC prepared Tables 1, 2 and NB, EB, and SF contributed by editing. All authors reviewed the manuscript for submission.

Corresponding author

Correspondence to Nicole D. Boswell.

Ethics declarations

Conflict of interest

Feldman has received research, speaking and/or consulting support from Eli Lilly and Company, GlaxoSmithKline/Stiefel, AbbVie, Janssen, Alovtech, vTv Therapeutics, Bristol-Myers Squibb, Samsung, Pfizer, Boehringer Ingelheim, Amgen Inc, Dermavant, Arcutis, Novartis, Novan, UCB, Helsinn, Sun Pharma, Almirall, Galderma, Leo Pharma, Mylan, Celgene, Valeant, Menlo, Merck & Co, Qurient Forte, Arena, Biocon, Accordant, Argenx, Sanofi, Regeneron, the National Biological Corporation, Caremark, Advance Medical, Suncare Research, Informa, UpToDate and the National Psoriasis Foundation. He is also the founder and majority owner of www.DrScore.com [drscore.com] and the founder and part owner of Causa Research. Nicole D. Boswell, Esther A. Balogh and Madison K. Cook have no conflicts to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boswell, N.D., Cook, M.K., Balogh, E.A. et al. The impact of complete clearance and almost complete clearance of psoriasis on quality of life: a literature review. Arch Dermatol Res 315, 699–706 (2023). https://doi.org/10.1007/s00403-022-02420-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-022-02420-5

Keywords

Search

Navigation