几种常见皮肤病和性病患者生活质量的研究

目的：研究湿疹、痤疮和非淋菌性尿道炎（NGU）对患者生活质量的影响。方法：采用皮肤病生活质量指数（DLQI）研究湿疹、痤疮和NGU患者的生活质量及其影响因素。结果：湿疹的DLQI值明显高于痤疮和NGU（P=0．001）。女性湿疹的DLQI值明显高于男性，未婚者的DLQI值高于已婚者，暴露部位受累者的DLQI值高于未受累者；男性痤疮患者的DLQI高于女性（P〈0．05）；男性NGU患者的DLQI值明显高于女性（P=0．003）。DLQI和EASI以及痤疮严重程度显著正相关（r=0．813，r=0．884；P〈0．001）。结论：湿疹对患者生活质量的影响较痤疮和NGU大，NGU对患者生活质量的影响与痤疮相当。     

银屑病患者生活质量调查

目的:研究银屑病对患者生活质量的影响及皮肤病生活质量指数(DLQI)作为判断银屑病病情及疗效新指标的可信性。方法:采用DLQI研究银屑病患者治疗前、后的生活质量及其影响因素,并与传统的银屑病皮损面积和严重度指数(PASI)进行比较。结果:女性患者的DLQI评分明显高于男性,未婚者的DLQI评分高于已婚者,面部受累者的DLQI评分高于面部未受累者(P<0.05)。DLQI和PASI评分呈显著正相关(r=0.633,P<0.001)。治疗后随着临床病情的改善,PASI和DLQI评分均显著下降,且DLQI改善率和PASI改善率呈显著正相关(r=0.722,P<0.001)。结论:银屑病对患者生活质量的影响较大,DLQI可作为判断银屑病病情及疗效的新指标。     

IL-18在寻常型银屑病患者皮损中的表达及其意义

目的：探讨白细胞介素18（Interleukin 18,IL-18）在寻常型银屑病患者皮损中的表达及其意义。方法：采用荧光定量聚合酶链反应法测定20例寻常型银屑病患者皮损中和17例正常对照者皮肤中IL-18mRNA的定量表达,采用直线相关回归分析方法分析IL-18mRNA的表达与寻常型银屑病病情严重指数（PASI）的关系。结果：寻常型银屑病皮损内IL-18mRNA明显高于正常对照者皮肤中的表达水平（U=-4．7698,P〈0．001）。寻常型银屑病皮损内IL-18mRNA的表达与患者PASI呈显著的正相关（r=0．96258,P〈0．001）。结论：IL-18的表达上调可能与寻常型银屑病的发生、发展有关。     

盐酸奥洛他定改善寻常性银屑病患者瘙痒症状的临床评价

目的评价盐酸奥洛他定治疗寻常性银屑病瘙痒的疗效。方法回顾分析77例伴随瘙痒的寻常性银屑病患者,在接受相同的常规抗银屑病治疗的同时,治疗组分别给予盐酸奥洛他定(n=29)和地氯雷他定(n=28)治疗,对照组未加抗组胺药(n=20),疗程1个月。治疗前后皮损用银屑病面积和严重程度指数评分(psoriasis area and severity index,PASI)、瘙痒用视觉模拟评分(visual analogue score,VAS)、动态瘙痒评分(dynamic pruritus score,DPS)和皮肤病生活质量指数(dermatology life quality index,DLQI)量表进行评估。结果奥洛他定组VAS评分的下降水平和DPS百分比明显高于对照组(P 0. 001)与地氯雷他定组(P 0. 05),而地氯雷他定组明显高于对照组(P 0. 05)。奥洛他定组(P 0. 001)和地氯雷他定组(P 0. 01)的DLQI评分下降的程度均明显高于对照组。以上差异均有统计学意义。结论抗组胺药对减轻寻常性银屑病患者的瘙痒有一定疗效,盐酸奥洛他定抗银屑病瘙痒的疗效更好。     

窄谱中波紫外线治疗前后银屑病皮损中CD1a^＋DC、Ki-67的表达

目的探讨窄谱中波紫外线（NB—UVB）治疗对银屑病患者皮损中CD1a^＋树突细胞（CD1a^＋DC）及Ki-67水平的影响。方法采用免疫组化法分析寻常性银屑病患者NB—UVB治疗前后皮损中及非皮损中CD1a^＋DC及Ki-67的表达。采用银屑病皮损面积和严重性指数（PASI）进行病情严重程度评分。结果27例银屑病患者中,治疗前皮损中CD1a^＋DC及Ki-67表达水平（15±4;53±12）高于非皮损（9±3;22±6）及治疗后患者皮损的表达量（9±3;25±1）（P〈0．05）。银屑病皮损的严重程度PASI评分与Ki-67表达相关（r=0．29,P〈0．05）。银屑病皮损的严重程度PASI评分与CD1a抗原的表达量之间无相关性（r=-0．27,P〉0．05）。结论NB—UVB可以通过调节皮肤免疫系统达到治疗目的。银屑病患者皮损中Ki-67表达水平与银屑病皮损的严重程度PASI评分有关。     

中国银屑病患者生活质量量表的编制与考评

目的:编制银屑病患者生活质量量表(psoriasis quality of life scale,PQOLS),并验证该量表信度和效度。方法:根据WHO对生活质量的定义提出理论框架,通过文献回顾和专家咨询的方式编制PQOLS测试版。然后采用初始量表测定银屑病患者的生活质量,根据结果对条目筛选,形成PQOLS的正式版。结果:通过文献回顾和专家咨询建立包含40个条目的备选条目池。通过条目筛选,最终形成了含22个条目的PQOLS,包括疾病、心理、生理、社会4个维度。对136例患者进行测试结果表明:量表各维度及整个量表的Cronbachα均0.8,Sperman-Brown系数均0.7;因子分析发现单因素能够代表量表的大多数因子;PQOLS与皮肤病生活质量指数(DLQI)的Pearson相关系数为0.821;PQOLS总分与银屑病皮损面积和严重程度指数(PASI)值的相关系数为0.506,生活质量与病情严重度呈显著负相关。结论:编制的PQOLS具有较好的信度、效度,适用于银屑病患者生活质量的测评。     

心理干预对银屑病患者生活质量的影响

为探讨心理干预对银屑病患者生活质量的影响。将64例银屑病患者随机分为治疗组和对照组，分别于心理干预前、后采用皮肤病生活质量指数（DLQI）问卷调查。结果：心理干预治疗后的患者生活质量明显改善（P〈0．01），而对照组治疗前、后无明显变化（P〉0．05）。银屑病除常规的躯体治疗外，应对患者实施心理干预，有助于提高患者的生活质量。     

中药浴加窄谱中波紫外线治疗寻常性银屑病疗效和生活质量分析

目的观察中药浴联合窄谱中波紫外线(narrow band ultraviolet B,NB-UVB)治疗寻常性银屑病临床疗效及其对患者生活质量的影响。方法将患者随机分为两组,治疗组(30例)采用中药浴联合NB-UVB治疗,对照组(30例)单独用NB-UVB治疗。结果治疗组银屑病面积和严重指数(psoriasis area and severity index,PASI)积分下降较对照组明显(P0.01),治疗组有效率为83.33%,而对照组有效率仅为53.33%,两者差异具有统计学意义(P0.05)。治疗后两组患者皮肤病生活质量指数(dermatology life quality index,DLQI)评分均有不同程度的改善,治疗组显著优于对照组(P0.01)。结论中药药浴联合NB-UVB对寻常性银屑病的疗效满意。     

乌司奴单抗治疗斑块状银屑病的疗效及不良反应观察

目的 探究乌司奴单抗治疗斑块型银屑病的疗效及不良反应,为其扩大临床应用提供参考。方法 选取2022年2月～2023年7月青海大学附属医院皮肤科门诊及住院部就诊的斑块状银屑病患者24例作为研究对象,均采取乌司奴单抗（Ustekinumab）治疗,评估患者治疗前后相关指标变化。结果 患者治疗前后的观察指标存在差异,银屑病面积与严重程度指数（PASI）评分、皮肤病生活质量指数（DLQI）评分较前明显改善,其差异具有统计学意义（P<0.05）。接受治疗第4周时,21例患者达到PASI 75,PASI 90患者也有3例;当达到12周治疗疗程时,PASI 75患者仅剩2例,高达22例患者实现PASI 90。未接受治疗时：PASI评分为（22.78±4.01）,治疗4周时,PASI评分为（13.57±4.57）,治疗12周时,PASI评分为（1.96±0.57）;治疗前：DLQI评分为（22.54±1.95）,治疗4周时,DLQI评分为（17.41±1.81）,治疗12周时,DLQI评分为（2.41±0.92）。治疗前,24例患者中有6例伴有关节症状,出现肿胀及压痛,治疗4周时,6例患者关节症...     

寻常型银屑病患者应用阿达木单抗、依那西普和英夫利昔单抗药物生存率比较

研究背景 既往研究对银屑病生物疗法的依从性尚缺乏长期随访数据。在丹麦,银屑病患者必须符合以下国家准则方可进行生物治疗：①寻常型银屑病诊断明确;②初次生物治疗者的疾病严重程度PASI评分〉10,或皮肤病生活质量指数（DLQI）〉10,或皮损占身体表面积〉10%;     

Psychometric properties of the Chinese version of dermatology life quality index (DLQI) in 851 Chinese patients with psoriasis

Background The Dermatology Life Quality Index (DLQI) is one of the most frequently used scales to evaluate the impact of skin disease on patients’ quality of life (QoL). There has not been psychometric evaluation of the Chinese version of DLQI in Chinese patients with psoriasis. Objective The objective of this study was to evaluate the psychometric properties of the Chinese version of DLQI. Methods Patients with psoriasis (≥18 years old) visiting nine hospitals in various regions of China were enrolled in the study. The DLQI, Psoriasis Disability Index (PDI) and Health Survey Short Form (SF‐36) were completed. Severity of psoriasis was assessed by the Psoriasis Area Severity Index (PASI). Reliability was estimated by internal consistency. Validity was assessed using known‐groups comparison, convergent validity and construct validity. Results In all, 851 patients were included in the study. The internal consistency reliability of the DLQI was high (Cronbach’s alpha = 0.91). Known‐groups comparison showed that the DLQI discriminated well among patients who differed in age, geographical region, duration of psoriasis and the PASI score. Evidence of convergent validity of the DLQI was proved by high correlations with the PDI and four subscales of SF‐36 (role‐physical, bodily pain, social functioning and role‐emotional): r = 0.52–0.78. Construct validity was proved by the presence of one‐factor structure that accounted for 55.9% of the variance and fitted well into the unidimensional model. Conclusion The Chinese version of DLQI is a reliable and valid measure to assess patient‐reported impact of skin disease and could be used in QoL and health outcome studies on Chinese psoriasis patients.     

Positive effect of modified Goeckerman regimen on quality of life and psychosocial distress in moderate and severe psoriasis

Psoriasis is a chronic inflammatory skin disease with a profound effect on quality of life and psychosocial stress. The relationship between clinical improvement and psycho-social impact after treatment is complex. The objective of this study was to compare changes in quality of life and psychosocial distress, and overall cost-effectiveness, in patients with psoriasis receiving the modified Goeckerman regimen (UV irradiation and coal tar) with those receiving conventional treatment. Patients with moderate/severe psoriasis receiving the Goeckerman regimen were followed from admission to discharge. Clinical severity, was evaluated weekly using the Psoriasis Area and Severity Index (PASI). Psoriasis Disability Index (PDI) and Hospital Anxiety and Depression Scale (HADS) questionnaires were applied at admission and one month after discharge. Thirty-six patients with psoriasis receiving conventional treatment and 48 patients receiving the Goeckerman regimen were recruited to the study. The mean PASI score in the Goeckerman group decreased from 27.1 to 6.9 and PDI scores decreased from 25.3 to 13.8. HADS scores for anxiety and depression decreased significantly from 9.8 to 6.3 and 9.1 to 6.8, respectively. In comparison with conventional therapy, the modified Goeckerman regime showed similar clinical efficacy, with additional benefits in improving overall quality of life and psychosocial distress in patients with moderate/severe psoriasis, and more cost-effectiveness.     

Comparison of Skindex-29, Dermatology Life Quality Index, Psoriasis Disability Index and Medical Outcome Study Short Form 36 in patients with mild to severe psoriasis

Background Severity assessment of patients with psoriasis is a critical issue. Classical clinical assessment has recently been combined with quality of life (QoL) scores, but several instruments are used. Moreover, studies have focused on patients with moderate to severe psoriasis. Objectives To compare the characteristics of QoL instruments in patients with the full range of psoriasis severity attending dermatology clinics. Methods Observational, prospective, multicentre study. Patients completed Skindex‐29 (anchor) and a second instrument randomly selected from Dermatology Life Quality Index (DLQI), Psoriasis Disability Index (PDI) and Medical Outcome Study Short Form 36 (SF‐36). Results Demographic data, Psoriasis Area and Severity Index and affected body surface area were not different between the three groups. Skindex‐29 showed a weak but significant correlation with clinical severity; only PDI showed similar correlation. PDI, DLQI and SF‐36 showed a substantial floor effect in patients with mild to severe psoriasis. Skindex‐29 showed strong correlations with the other three QoL instruments. SF‐36 was more sensitive than the other instruments in detecting worse QoL in male patients. Conclusions Skindex‐29 has better sensitivity to clinical severity with minimal floor effect, and covers the main domains explored by the other three QoL instruments in patients with mild to severe psoriasis.     

Efficacy of a far erythemogenic dose of narrow-band ultraviolet B phototherapy in chronic plaque-type psoriasis

The aim of the present study was to examine the effect of far erythemogenic dose of narrow-band ultraviolet B (NB-UVB; starting dose at 35% minimal erythematous dose [MED]) on clinical response by measuring the severity, extent of disease and the changes in quality of life. Fifty patients with chronic plaque-type psoriasis were enrolled. Therapy was held for 3 days a week. The severity of the disease was assessed based on the Psoriasis Area and Severity Index (PASI) score and Dermatology Life Quality Index (DLQI) scores. The percentage improvement of PASI at 30 sessions was 68.99%. The improvement in DLQI scores at 30 sessions was 79.67%. Pearson correlation coefficients showed that PASI scores were not correlated with DLQI scores at the beginning of treatment ( P  = 0.330, r  = 0.14), but after the 30th session of NB-UVB therapy improvements in quality of life were correlated ( P  < 0.05, r  = 0.399). Therefore, far erythemogenic dose of NB-UVB is considered to be effective treatment for plaque-type psoriasis in our patients. However, we cannot confirm that it is safer than higher MED starting dose in term of cumulative UV irradiation.     

Educational and motivational support service: a pilot study for mobile‐phone‐based interventions in patients with psoriasis

Background Psoriasis is a chronic disease which requires long‐term therapy. Therefore, adherence to therapy and patient motivation are key points in controlling the disease. Mobile‐phone‐based interventions, and in particular text messages (TM), have already been used effectively to motivate patients and improve treatment adherence in many different chronic diseases such as diabetes, cardiovascular disease and asthma. Objectives To evaluate the use of TM in improving treatment adherence and several patient outcomes such as quality of life, disease severity, patient‐perceived disease severity and the patient–physician relationship. Patients and methods Daily TM, providing reminders and educational tools, were sent for 12 weeks to a group of 20 patients with psoriasis. At the beginning and end of the study the following assessments were performed: Psoriasis Area Severity Index (PASI), Self‐Administered Psoriasis Area Severity Index (SAPASI), body surface area (BSA), Physician Global Assessment (PGA), Dermatology Life Quality Index (DLQI), evaluation of patient–physician relationship and adherence to therapy. A matched control group of 20 patients with psoriasis was used for comparison of the same outcomes. Results Both patient groups had similar scores for PASI, SAPASI, BSA, PGA and DLQI at baseline. However, after 12 weeks the intervention group reported a significantly better improvement of disease severity as well as quality of life, showing lower values of PASI, SAPASI, BSA, PGA and DLQI with respect to the control group (P < 0·05). Moreover, adherence to therapy improved in a statistically significant way (P < 0·001) whereas it remained stable in the control group. Similarly, TM interventions led to an optimization of patient–physician communication. Conclusions TM interventions seem to be a very promising tool for the long‐term management of patients with psoriasis, leading to an increased compliance to therapy, positive changes in self‐care behaviours and better patient–physician relationship allowing improved clinical outcomes and better control of the disease.     

Analysis of three outcome measures in moderate to severe psoriasis: a registry-based study of 2450 patients

Summary Background As moderate to severe psoriasis is a systemic disease with large effects on health‐related quality of life, generic measures that include overall health, not only skin involvement, are necessary. Knowledge about the relationship between the generic preference‐based EuroQol 5D (EQ‐5D) and dermatology‐specific measures in psoriasis is limited. Objectives To analyse EQ‐5D, the Dermatology Life Quality Index (DLQI) and the Psoriasis Area and Severity Index (PASI) in patients with moderate to severe psoriasis in Swedish clinical practice by demographic characteristics, to compare EQ‐5D among patients vs. Swedish population values, and to analyse the relationships between EQ‐5D, DLQI and PASI. Methods This observational cohort study was based on PsoReg, the Swedish National Registry for Systemic Treatment of Psoriasis. EQ‐5D was compared among patients with psoriasis vs. a defined general population in Sweden, retrieved from a previous study. Relationships between measures were examined with correlation tests and regression analysis. Results In total, 2450 patients (1479 men and 971 women) were included. Median EQ‐5D, DLQI and PASI scores were 0·769, 4 and 4·7, respectively. Patients with psoriasis had a significantly lower EQ‐5D compared with the defined general population. EQ‐5D correlated moderately with DLQI (?0·55) and weakly with PASI (?0·25) (P < 0·001). Conclusions When assessing psoriasis treatments and making decisions about treatment guidelines and resource allocation, EQ‐5D, DLQI and PASI provide a useful set of complementary tools, answering to different needs. If EQ‐5D is not included in the original trial the second‐best option in cost‐effectiveness studies is to use mapping between DLQI and EQ‐5D.     

Long‐term evaluation of climatotherapy for psoriasis

Climatotherapy (CT) is a treatment with immediate high clearance rate for chronic psoriasis, but evidence of long‐term effects is scarce. Assessment of the impact of a single CT treatment on disease activity and quality of life was carried out at 4‐ to 6‐month follow‐ups. A prospective study of patients with psoriasis undergoing 4 weeks of CT in Israel describes long‐term outcomes of CT. Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores were assessed before CT and at an average of 5 months after return. Assessment of the eligibility for CT takes place twice a year. A total of 49 patients (28/21 M/F) participated. Pretreatment PASI was 2.6 to 18.7 (mean 8.1 ± 3.8) vs control PASI 0 to 16.9 (mean 5 ± 2.8), (P < .0001). Mean ΔPASI was 3.2 (39.5% reduction). PASI 75 was achieved by 11/49 patients; 10/49 had increased PASI. The mean DLQI score was 16.1 (range 2‐30); 10.6 at follow‐up (range 0‐28), and 33 patients achieved DLQI minimal clinically important difference (P < .0001). Age, sex, number of previous CT, and duration of observation period did not affect endpoints. CT and unmonitored self‐treatment induces PASI 75 in one‐fifth patients at follow‐up 4 to 6 months later. Six of 10 patients report a clinically important improvement of patients' quality of life as measured by DLQI.     

Clear or almost clear skin improves the quality of life in patients with moderate‐to‐severe psoriasis: a systematic review and meta‐analysis

Psoriasis Area and Severity Index (PASI) 75 response is currently considered the gold standard for assessing treatment efficacy in moderate‐to‐severe psoriatic patients. PASI 90 response denotes better clinical improvement compared to PASI 75. Very few studies have assessed if a greater PASI clinical response is associated with greater improvements in Dermatology Life Quality Index (DLQI). A systematic review and meta‐analysis was performed to assess the association between PASI response and DLQI. The study was conducted to assess whether greater improvement in PASI scores from PASI 75–89 to PASI 90 is associated with greater Quality of life (QoL) improvements, specifically DLQI scores. Systematic searches were conducted in MEDLINE, EMBASE and Cochrane Library to identify studies evaluating biologic interventions in adult moderate‐to‐severe psoriasis patients reporting PASI response and their corresponding DLQI change from baseline score. The quality of evidence was assessed through Jadad score for randomized controlled trials and Downs and Black's checklist for observational studies. Meta‐analysis estimated change from baseline in DLQI for PASI 75–89 responders to be 78% (95% credible intervals [CrI]: 75–82%) and for PASI 90 responders to be 90% (95% CrI: 88–93%). This implies 12% greater improvement in DLQI score for PASI 90 responders compared with PASI 75–89 responders. In addition, the meta‐analysis also showed a statistically significant difference in DLQI score of 0/1 between PASI 75‐89 and PASI 90 responders (45% [95% Crl]; 41.0–50.0% and 73% [95% Crl]; 70.0–76.0%), respectively, Bayesian P < 0.0001). In conclusion, substantial improvement in clinical efficacy is associated with improved QoL in patients with moderate‐to‐severe psoriasis suggesting that PASI 90 responders (clear or almost clear skin) could achieve a superior QoL compared to PASI 75–89 responders.     

Assessment of medication adherence and treatment satisfaction in Japanese patients with psoriasis of various severities

Psoriasis is a chronic, relapsing, inflammatory keratotic skin disease. To elucidate the medication adherence and treatment satisfaction, we performed a questionnaire survey using the eight‐item Morisky Medication Adherence Scale (MMAS‐8) and nine‐item Treatment Satisfaction Questionnaire for Medication (TSQM‐9) of 163 psoriatic patients who regularly visited hospitals or clinics. To assess the relationship between the MMAS‐8/TSQM‐9 outcomes and severity of psoriasis, two different clinical severity indices were used: the Psoriasis Area and the Severity Index (PASI) for disease severity and the Psoriasis Disability Index (PDI) for quality of life (QOL) impairment. The MMAS‐8 score for oral medication was significantly higher than that for topical medication. The oral and topical MMAS‐8 scores were significantly correlated with the PDI score, but not with the PASI score, indicating that QOL impairment lowered treatment motivation. All of the TSQM‐9 domain scores (effectiveness, convenience and global satisfaction) were significantly correlated with both the PASI and PDI scores, suggesting that patients whose skin and QOL conditions were under good control had high satisfaction with treatment. Patients treated with biologics had higher satisfaction than those treated with non‐biologics.