European Journal of Pediatrics

, Volume 171, Issue 3, pp 485–492

Health-related quality of life of pediatric patients with moderate to severe plaque psoriasis: comparisons to four common chronic diseases

  • James W. Varni
  • Denise R. Globe
  • Shravanthi R. Gandra
  • David J. Harrison
  • Michele Hooper
  • Scott Baumgartner
Original Paper


Health-related quality of life (HRQOL) is an important indicator of the burden of illness in moderate-to-severe plaque psoriasis. This study evaluated self-reported generic HRQOL among pediatric patients with moderate-to-severe plaque psoriasis based on pooled baseline clinical trial data and compared them to four common chronic diseases and to a healthy sample. The Pediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) Generic Core Scales was administered to 208 patients ages 4 to 17 years with stable, moderate-to-severe plaque psoriasis. Patients with moderate-to-severe plaque psoriasis were compared using one-sample t-tests to published PedsQL™ ( data on healthy children and pediatric patients with arthritis, psychiatric disorders, asthma, and diabetes. Pediatric patients with moderate-to-severe plaque psoriasis demonstrated significantly impaired physical, emotional, social, and school functioning in comparison to healthy children. The PedsQL™ Emotional and School Functioning Scales demonstrated the largest mean difference between the two groups (12.1, 11.1 points, respectively). In general, patients with plaque psoriasis demonstrated significantly more impaired generic HRQOL compared to patients with diabetes, comparable HRQOL to arthritis and asthma, and better HRQOL than psychiatric patients. In conclusion, the findings indicate that pediatric patients with moderate-to-severe plaque psoriasis have significantly impaired generic HRQOL in comparison to healthy children, and HRQOL generally comparable to other serious chronic diseases. These results demonstrate the significant negative impact of plaque psoriasis on the daily lives of these children from the patients’ perspective.


Plaque psoriasis Pediatrics PedsQL Health-related quality of life Patient-reported outcomes 



Pediatric Quality of Life Inventory™


Food and Drug Administration


Health-related quality of life




Body-surface area


Psoriasis area-and-severity index


Confidence interval


  1. 1.
    Bastiaansen D, Koot HM, Bongers IL, Varni JW, Verhulst FC (2004) Measuring quality of life in children referred for psychiatric problems: psychometric properties of the PedsQL™ 4.0 Generic Core Scales. Qual Life Res 13:489–495PubMedCrossRefGoogle Scholar
  2. 2.
    Bastiaansen D, Koot HM, Ferdinand RF, Verhulst FC (2004) Quality of life in children with psychiatric disorders: self, parent, and clinician report. J Am Acad Child Adolesc Psychiatry 43:221–230PubMedCrossRefGoogle Scholar
  3. 3.
    Beattie PE, Lewis-Jones MS (2006) A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol 155:145–151PubMedCrossRefGoogle Scholar
  4. 4.
    Clarke SA, Eiser C (2004) The measurement of health-related quality of life in pediatric clinical trials: a systematic review. Health Qual Life Outcomes 2(66):1–5Google Scholar
  5. 5.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, HillsdaleGoogle Scholar
  6. 6.
    de Jager MEA, van de Kerkhof PCM, de Jong EMGJ, Seyger MMB (2010) A cross-sectional study using the Children’s Dermatology Life Quality Index (CDLQI) in childhood psoriasis: negative effect on quality of life and moderate correlation of CDLQI with severity scores. Br J Dermatol 163:1099–1101PubMedCrossRefGoogle Scholar
  7. 7.
    Dillman DA, Smyth JD, Christian LM (2009) Internet, mail and mixed-mode surveys: the tailored design method. Wiley, New YorkGoogle Scholar
  8. 8.
    FDA (2009) Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims. Food and Drug Administration, U.S. Department of Health and Human Services, Rockville, MDGoogle Scholar
  9. 9.
    Fredriksson T, Pettersson U (1978) Severe psoriasis: oral therapy with a new retinoid. Dermatologica 157:238–244PubMedCrossRefGoogle Scholar
  10. 10.
    Gelfand JM, Feldman SR, Stern RS, Thomas J, Rolstad T, Margolis DJ (2004) Determinants of quality of life in patients with psoriasis: a study from the US population. J Am Acad Dermatol 51:704–708PubMedCrossRefGoogle Scholar
  11. 11.
    Heydendael VMR, de Borgie CAJM, Spuls PI, Bossuyt PMM, Bos JD, de Rie MA (2004) The burden of psoriasis is not determined by disease severity only. J Invest Dermatol Symp Proc 9:131–135CrossRefGoogle Scholar
  12. 12.
    Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y (2005) The psychosocial burden of psoriasis. Am J Clin Dermatol 6:383–392PubMedCrossRefGoogle Scholar
  13. 13.
    Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T (1998) The impact of psoriasis on quality of life. Arch Dermatol 137:280–284Google Scholar
  14. 14.
    Langley RG, Paller AS, Hebert AA, Creamer K, Weng HH, Jahreis A, Globe D, Patel V, Orlow SJ (2011) Patient-reported outcomes in pediatric patients with psoriasis undergoing etanercept treatment: 12-week results from a phase III randomized controlled trial. J Am Acad Dermatol 64:64–70PubMedCrossRefGoogle Scholar
  15. 15.
    Lewis-Jones MS, Finlay AY (1995) The Children’s Dermatology Life Quality Index (CDLQI): initial validation and practical use. Br J Dermatol 132:942–949PubMedCrossRefGoogle Scholar
  16. 16.
    Paller AS, Siegfried EC, Langley RG, Gottlieb AB, Pariser D, Landells I, Hebert AA, Eichenfield LF, Patel V, Creamer K, Jahreis A (2008) Etanercept treatment for children and adolescents with plaque psoriasis. New Engl J Med 358:241–251PubMedCrossRefGoogle Scholar
  17. 17.
    Patrick DL, Deyo RA (1989) Generic and disease-specific measures in assessing health status and quality of life. Med Care 27:S217–S233PubMedCrossRefGoogle Scholar
  18. 18.
    Rapp SR, Feldman SR, Exum ML, Fleischer AB, Reboussin DM (1999) Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 41:401–407PubMedCrossRefGoogle Scholar
  19. 19.
    Revicki DA, Menter A, Feldman SR, Kimel M, Harnam N, Willian MK (2008) Adalimumab improves health-related quality of life in patients with moderate to severe plaque psoriasis compared with the United States general population norms: results from a randomized, controlled Phase III study. Health Qual Life Outcomes 6(75):1–8Google Scholar
  20. 20.
    Russo PA, Ilchef R, Cooper AJ (2004) Psychiatric morbidity in psoriasis: a review. Australasian J Dermatol 45:155–161CrossRefGoogle Scholar
  21. 21.
    Sampogna F, Tabolli S, Soderfeldt B, Axtelius B, Aparo U, Abeni D (2006) Measuring quality of life of patients with different clinical types of psoriasis using the SF-36. Br J Dermatol 154:844–849PubMedCrossRefGoogle Scholar
  22. 22.
    Shikiar R, Willian MK, Okun MM, Thompson CS, Revicki DA (2006) The validity and responsiveness of three quality of life measures in the assessment of psoriasis patients: results of a phase II study. Health Qual Life Outcomes 4(17):1–12Google Scholar
  23. 23.
    Upton P, Lawford J, Eiser C (2008) Parent-child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res 17:895–913PubMedCrossRefGoogle Scholar
  24. 24.
    Varni JW, Burwinkle TM, Jacobs JR, Gottschalk M, Kaufman F, Jones KL (2003) The PedsQL™ in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory™ Generic Core Scales and type 1 Diabetes Module. Diabetes Care 26:631–637PubMedCrossRefGoogle Scholar
  25. 25.
    Varni JW, Burwinkle TM, Rapoff MA, Kamps JL, Olson N (2004) The PedsQL™ in pediatric asthma: reliability and validity of the Pediatric Quality of Life Inventory™ Generic Core Scales and Asthma Module. J Behav Med 27:297–318PubMedCrossRefGoogle Scholar
  26. 26.
    Varni JW, Burwinkle TM, Seid M, Skarr D (2003) The PedsQL™ 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 3:329–341PubMedCrossRefGoogle Scholar
  27. 27.
    Varni JW, Limbers CA, Burwinkle TM (2007) How young can children reliably and validly self-report their health-related quality of life? An analysis of 8,591 children across age subgroups with the PedsQL™ 4.0 Generic Core Scales. Health Qual Life Outcomes 5(1):1–13PubMedCrossRefGoogle Scholar
  28. 28.
    Varni JW, Limbers CA, Burwinkle TM (2007) Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL™ 4.0 Generic Core Scales. Health Qual Life Outcomes 5(43):1–15PubMedCrossRefGoogle Scholar
  29. 29.
    Varni JW, Seid M, Knight TS, Burwinkle TM, Brown J, Szer IS (2002) The PedsQL™ in pediatric rheumatology: reliability, validity, and responsiveness of the Pediatric Quality of Life Inventory™ Generic Core Scales and Rheumatology Module. Arthritis Rheum 46:714–725PubMedCrossRefGoogle Scholar
  30. 30.
    Varni JW, Seid M, Kurtin PS (2001) PedsQL™ 4.0: reliability and validity of the Pediatric Quality of Life Inventory™ version 4.0 Generic Core Scales in healthy and patient populations. Med Care 39:800–812PubMedCrossRefGoogle Scholar
  31. 31.
    Varni JW, Seid M, Rode CA (1999) The PedsQL™: measurement model for the Pediatric Quality of Life Inventory. Med Care 37:126–139PubMedCrossRefGoogle Scholar
  32. 32.
    World Health Organization (1948) Constitution of the World Health Organization: basic document. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • James W. Varni
    • 1
    • 2
  • Denise R. Globe
    • 3
  • Shravanthi R. Gandra
    • 3
  • David J. Harrison
    • 3
  • Michele Hooper
    • 3
  • Scott Baumgartner
    • 3
  1. 1.Department of Pediatrics, College of MedicineTexas A&M UniversityCollege StationUSA
  2. 2.Department of Landscape Architecture and Urban Planning, Center for Health Systems + Design, College of ArchitectureTexas A&M UniversityCollege StationUSA
  3. 3.AmgenThousand OaksUSA

Personalised recommendations