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Physical and psychologic measures are necessary to assess overall psoriasis severity,☆☆,

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Abstract

Background: The assessment of psoriasis severity is complex and involves both the physical and psychologic assessment of the individual patient. Objective: We compared the Salford Psoriasis Index and several other tools for assessing psoriasis severity for their abilities to assess both the physical and psychologic effects of psoriasis. Methods: A total of 101 patients (44 women, 57 men) were assessed by means of the Salford Psoriasis Index (SPI), Psoriasis Area and Severity Index (PASI), Self-Administered PASI (SAPASI), Psoriasis Disability Index (PDI), Hospital Anxiety and Depression Scale (HADS), and Illness Perception Questionnaire (IPQ). Results: The “signs” score of SPI (which measures the clinical extent of psoriasis), PASI, and SAPASI correlated well with each other (r = 0.69-0.99; P < .01). They also correlated significantly, but not as strongly, with scores of psoriasis-induced disability, the PDI and SPI “psychosocial disability” score (r = 0.46-0.51; P < .01), but not with general measures of psychologic distress. There was no significant correlation between the historical treatment, “intervention,” score in SPI and either the physical or the psychologic score in the SPI. The PDI and “psychosocial disability” score of SPI correlated well with each other (r = 0.69; P < .01) as well as with the depression and anxiety subscale scores of HADS (r = 0.33 and r = 0.37; P < .01, respectively), the total number of symptoms suffered by the patient (r = 0.38; P < .01), and the belief that stress or worry were associated with psoriasis (r = 0.33; P < .01). Conclusion: Physical scores of psoriasis severity such as PASI, SAPASI, and the “signs” component of SPI give a partial indication of psychosocial disability caused by psoriasis. In many patients, however, the physical score does not reflect psychosocial disability. Patients should be assessed by a more holistic approach, which takes into account both physical and psychologic measurements, such as used in SPI, when assessing the severity of psoriasis. (J Am Acad Dermatol 2001;45:72-6.)

Section snippets

Patients and methods

Patients with psoriasis were recruited from the dermatology inpatient ward, the specialist psoriasis clinic, and general dermatological clinics at the Dermatology Centre, Hope Hospital, Manchester, United Kingdom. All patients were 18 years of age or older and were not suffering from any severe mental health problems. The patients completed the SAPASI and several self-report psychologic questionnaires. The PASI was assessed in each patient by 1 of 3 clinicians (B. K., P. W., E. H.) experienced

Results

One hundred one patients with psoriasis (44 women, 57 men; mean age, 46 ± 1.7 years; range, 18-88 years) were assessed. This included 67 inpatients (30 women, 37 men; mean age, 46.4 ± 2.1 years; range, 18-88 years) and 34 outpatients (14 women, 20 men; mean age, 45.6 ± 3.1 years; range, 20-76 years). The overall mean PASI score was 14.7 ± 1.1.

Discussion

Psoriasis can cause significant physical and psychologic morbidity in those whom it affects.1, 6, 12 However, traditional measurements of psoriasis severity have concentrated on the physical aspects of the disease.2, 3, 13 Recently, indices have been developed that measure psoriasis-specific distress.4, 5 Although it is known that one of these, the PDI, correlates significantly but not completely with PASI,5 the psychometric properties of either PASI or PDI are unclear. Similarly, the SAPASI

Acknowledgements

We thank Dr A. B. Fleischer and Professor A. Y. Finlay for allowing us to use the Self-Administered PASI and Psoriasis Disability Index, respectively.

References (17)

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B. Kirby is supported in part by an unrestricted grant from Novartis Pharmaceuticals Limited.

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J Am Acad Dermatol 2001;45:72-6.

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