Effectiveness of short-term physical agents treatment on macroscopic morphology in patients with plaque psoriasis / Efectividad del tratamiento a corto plazo de los agentes físicos en la morfología macroscópica de las placas de psoriasis

Psoriasis is a chronic inflammatory disease that presents skin rashes which can arise through plaques. The aim of this work was to compare the effectiveness of short-term physical agents treatment on macroscopic morphology (area and erythema) in patients with plaque psoriasis. This prospective randomized experimental study included fourteen subjects, medically diagnosed with psoriasis, with more than one plaque in the skin and voluntarily without topical treatment. All subjects completed the study that consisted of 12 treatment sessions divided in control (C), artificial balneotherapy (AB), phototherapy (PT) or balneophototherapy (BPT) groups. After session 12, there was a significant reduction of the plaque area by all treatments when compared to C group and BPT was the most effective one. However, only AB and PT presented a reduction of erythema. Regarding severity, 9 patients changed to a lower category on the PASI test, and 5 of them maintained a mild psoriasis, but lowered their score. Finally, 13 of 14 subjects improved their quality of life. The physical agents used reduced the severity of psoriasis and improved quality of life of patients after 12 sessions of treatment during a onemonth period. The BPT was the more effective in controlling psoriasis by diminishing its area and PT by attenuating the erythema.

La Psoriasis es una enfermedad inflamatoria crónica que presenta irritación cutánea que puede derivar a placas. El objetivo de este trabajo fue comparar la efectividad del tratamiento a corto plazo con agentes físicos en la morfología macroscópica (área y eritema) en pacientes con placas de psoriasis. Estudio experimental, prospectivo, randomizado. Catorce sujetos participaron con diagnóstico médico de psoriasis, con más de una placa en la piel y sin tener tratamiento tópico de forma voluntaria. Todos los sujetos completaron el estudio, el cual consistió de 12 sesiones de tratamiento dividido en grupo control (C), BA, FT y BFA. Posterior a la sesión 12, se observó una reducción significativa en toda el área de las placas que recibieron tratamiento al compararlas al grupo C y el grupo BFA fue el más efectivo. Sin embargo, solo los grupos BA y FT presentaron una reducción del eritema. Respecto a la severidad, 9 pacientes cambiaron de la baja categoría en el test de PASI y 5 de ellos se mantuvieron en el nivel medio, pero disminuyeron su puntaje. Finalmente, 13 de 14 sujetos mejoraron su calidad de vida. Los agentes físicos usados redujeron la severidad de la psoriasis y mejoraron la calidad de vida de los pacientes después de 12 sesiones de tratamiento durante el período de un mes. La BFA fue la más efectiva en controlar la psoriasis por la disminución en el área y la FT por la atenuación del eritema.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis

Abstract: Background: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. Objectives: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. Methods: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. Results: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. Study limitations: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. Conclusions: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

Impact of psoriasis in the quality of life of children, adolescents and their families: a cross-sectional study

Abstract: Background: Psoriasis is a chronic and inflammatory disease that impairs quality of life and causes psychological symptoms. Despite the high prevalence of psoriasis in pediatric patients, studies investigating the impact of psoriasis in the quality of life of children, adolescents and families are sparse. Objective: To investigate the impact of psoriasis in the quality of life of children and adolescents with psoriasis and their families and to determine depression and anxiety levels of the patients. Methods: A total of 58 patients with psoriasis aged 7-18 years (median age: 11) and a family member of each patient were included in the study. Children's Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), Children's Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIC) were used in the study. Results: The median PASI score of the patients included in the study was 1.8. The median CDLQI and FDLQI scores in the study groups were 5 and 10, respectively. The median CDI score, STAIC-state and STAIC-trait scores of the patients were 6, 28 and 32.5, respectively. Study limitations: Lack of a control group and patient assessment of disease severity. Relatively mild disease severity of the subjects. Conclusions: Psoriasis has a negative impact in the quality of life of children, adolescents and their families, even in the presence of mild disease. Considering that impairment in quality of life may be associated with psychosocial morbidity, a combined approach with medical therapy, family counseling and quality of life assessment may be beneficial in this patient group.

The association between psoriasis and health-related quality of life, work productivity, and healthcare resource use in Brazil

Abstract: Background: Psoriasis is a chronic, immune mediated inflammatory condition that affects a significant amount of the global population. Yet geographic variability in the consequences of psoriasis warrants region-level analyses. Objective: The current study contributes to the psoriasis outcomes literature by offering a comprehensive assessment of the humanistic and economic burden in Brazil. Methods: The 2012 Brazil National Health and Wellness Survey (N=12,000) was used to assess health-related quality of life (Short Form-12, version 2), work productivity, and healthcare resource use associated with experiencing psoriasis vs. no psoriasis, along with varying levels of psoriasis severity. Results: A total of 210 respondents reported diagnosis of psoriasis (N=157, 42, and 11 reporting mild, moderate, and severe psoriasis, respectively). Compared with controls, respondents with psoriasis reported diminished mental component summary scores and health utilities, as well as increased presenteeism, activity impairment, and physician visits over the past six months, adjusting for covariates. Among those with psoriasis, physical health decreased as psoriasis severity increased. Although work productivity and healthcare resource utilization did not differ with psoriasis severity, the high rates of productivity loss (e.g. 45.5% presenteeism in the severe psoriasis group) suggest an economic burden. Study limitations: Cost analyses were not performed, and cross-sectional patient-reported data limit causal conclusions and may reflect reporting biases. Conclusions: Nevertheless, these results suggest a significant burden to patients with psoriasis across both humanistic and economic outcomes. The association between psoriasis and mental health aspects and health utilities were particularly strong and exceeded what would be considered clinically meaningful.

Psychopathology and alexithymia in patients with psoriasis

Abstract: Background: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. Objective: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. Methods: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. Results: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. Study Limitations: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. Conclusions: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis.

The relationship between pruritus and clinical variables in patients with psoriasis

Abstract: Background: Pruritus is the most commonly occurring subjective symptom of dermatological disease. Published data on both prevalence and intensity of pruritus in psoriasis is limited. Objective: In this study we aimed to investigate the prevalence of pruritus and its relation with psoriasis area severity index, body mass index and presence of systemic disease in patients with psoriasis. Methods: We analyzed data of psoriatic patients diagnosed in our psoriasis outpatient clinic between March 2013 and June 2014 collected retrospectively from PSR-TR registration system. Results: In total, 880 patients were analyzed. Pruritus was more prominent in female patients. This difference was statistically significant. No significant associations were found between age of patients, clinical type of disease and pruritus. The itching was more common in patients with higher body mass index. Presence of pruritus was correlated significantly with severity of psoriasis. Five hundred and sixty of 880 patients had no systemic disease. The presence of pruritus was not related with presence of systemic disease. Existence of systemic disease with psoriasis has minimal effect on pruritus. Study Limitations: We did not evaluate intensity of pruritus. Conclusions: Pruritus is not mentioned within the classical symptoms of psoriasis. Pruritus in psoriasis is a very unpleasant symptom with great potential to impair patient's quality of life and may exacerbate psoriasis as a Koebner phenomenon.

Estudio de la proxémica, el contacto y la expresión de las emociones en una muestra de pacientes con psoriasis / Study of proxemics, contact and emotional expression in a psoriasis patients' sample

Antecedentes: la relación entre alexitimia y psoriasis es compleja y está vinculada con procesos de separación-individuación y con problemáticas en el desarrollo de un apego seguro para establecer relaciones de confianza y regular las emociones y el estrés. Objetivos: analizar la proxémica, el contacto y la expresión emocional de los pacientes con psoriasis en los vínculos materno-filiales y del área sexual. Método: en un estudio correlacional a 51 personas con psoriasis y 56 controles se les aplicaron diferentes instrumentos para evaluar Alexitimia, Apego y Proxémica. Resultados: las personas con psoriasis demostraron mayor evitación del contacto en la sexualidad. La evitación del contacto fue superior al conjugarse la presencia de alexitimia y de psoriasis. Conclusiones: las personas con psoriasis tendrían un menor contacto en la sexualidad y más respuestas fusionales o de lejanía en la relación niño-madre sugiriendo problemáticas de apego. Los resultados obtenidos con los instrumentos administrados sugieren que la alexitimia podría afectar la sexualidad y se potenciaría con la psoriasis generando dificultades de contacto.

Background: the relationship between alexithymia and psoriasis is complex and is related to separation-individualization processes and to difficulties in the development of a secure attachment to establish trustful relationships and to regulate emotions and stress. Objectives: to analyze psoriasis subjective factors such us proxemics, contact and emotional expression on people with psoriasis on their mother-child and sexual bonds. Method: in a correlational study, different scales were applied to 51 psoriasis patients and 56 controls to evaluate Alexithymia, Attachment and Proxemics. Results: people with psoriaris showed more contact avoidance in the sexuality area. Avoidance of contact was greater when alexithymia and psoriasis appeared together. Conclusions: people with psoriasis could have less sexual contact and greater fusional or distance responses on the son-mother bond suggesting difficulties in attachment. Alexithymia could affect sexuality and it could maximize its effects when combined with psoriasis producing contact difficulties.

Psicodermatología en la atención primaria / Psychodermatology in primary care

The skin has the distinction of being the largest, visible and accessible part of the human body, and it hides a close and old relationship with the human psyche, and so has been demonstrated in the last years, where more elements of the Mental Health are elucidated playing a role in the pathogenesis of skin diseases, as well as there are some descriptions of the inverse relationship, this is, on how the skin diseases affect Mental Health of the individual. In this paper we propose to emphasize the importance of the issue, to consider a comprehensive approach to everyday Dermatology in Primary Care Medicine.

Quality of life and psychosocial aspects in Greek patients with psoriasis: a cross-sectional study

Abstract: BACKGROUND: Psoriasis is a common, long-term skin disease associated with high levels of psychological distress and a considerable adverse impact on life. The effects of psoriasis, beyond skin affliction, are seldom recognized and often undertreated. OBJECTIVE: The aim of the study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients with psoriasis. METHODS: Eighty-four patients with psoriasis were enrolled in the study. The quality of life, depression and anxiety, loneliness and self-esteem of the patient were assessed using the Dermatology Life Quality Index, Hospital Anxiety and Depression Scale, the UCLA loneliness Scale (UCLA-Version 3) and Rosenberg's Self-esteem Scale, respectively. RESULTS: The Dermatology Quality of Life Index score among psoriasis patients was 12.61 ± 4.88. They had statistically significantly higher scores according to the Hospital Anxiety and Depression Scale -anxiety subscale (p=0.032)-compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale (p=0.033) and RSES-scale (p<0.0001). Female patients presented with lower self-esteem than male patients. CONCLUSION: Psoriasis is a distressing, recurrent disorder that significantly impairs quality of life. Therefore, the recognition and future management of psoriasis may require the involvement of multi-disciplinary teams to manage the physical, psychological and social aspects of the condition, as is the case for systemic, long-term conditions.

Distribution pattern of psoriasis, anxiety and depression as possible causes of sexual dysfunction in patients with moderate to severe psoriasis

Abstract BACKGROUND: Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relation. However, beyond genital psoriasis, the importance of the disease's distribution patterns has not been considered. OBJECTIVES: To research sexual function in psoriasis patients and investigate the roles of anxiety, depression and psoriasis' distribution patterns in sexual dysfunction. METHODS: A comparative study matched for sex and age was performed. Eighty patients with moderate to severe psoriasis and 80 healthy controls were included. The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS: Psoriasis was associated with sexual dysfunction, odds ratio=5.5 (CI 95% 2.6-11.3; p<0.001). Certain distribution patterns of psoriasis, involving specific body regions, were associated with an increase in sexual dysfunction in the group presenting the disease, odds ratio 7.9 (CI 95% 2.3-33.4; p<0.001). Multivariate logistic regression analysis identified anxiety and depression, and the involvement of these specific areas, as possible independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSION: This study identifies body areas potentially related to sexual dysfunction, independently of anxiety and depression, in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when choosing the treatment for psoriasis patients. .

Psoriasis: classical and emerging comorbidities

Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis.

Psoriasis severity and hypothalamic-pituitary-adrenal axis function: results from the CALIPSO study

Psoriasis is a chronic inflammatory disease that significantly impacts life quality, being associated with stress and mental disorders. We investigated whether the activity of the hypothalamic-pituitary-adrenal (HPA) axis was associated with psoriasis severity, daily life stress and anxiety, and depressive symptoms. In this ancillary study, which was part of the CALIPSO (coronary artery calcium in psoriasis) study, saliva was collected from 102 patients with psoriasis immediately upon awakening, 30, and 60 min after awakening, at 2:00 pm and at bedtime (five time points) to determine salivary cortisol levels. We used Pearson's correlation coefficient to evaluate the association of clinical and psychopathological variables with HPA activity. We found a direct correlation between bedtime cortisol and psoriasis severity evaluated by the psoriasis area severity index (PASI; r=0.39, P<0.001). No correlations between other clinical and psychopathological variables or with other cortisol assessments were observed. The findings indicated that HPA dysfunction may be present in psoriasis, as bedtime cortisol was correlated with psoriasis severity. Our study is limited by the lack of a control group; therefore, we were not able to explore whether these cortisol values were different compared with a concurrent, healthy sample.

Caboclo na cidade / Caboclo in the city / Un mestizo en la ciudad

A partir de um caso clínico de um morador da zona rural que migra para o centro urbano, destaca-se a vivência de inadequação provocada pelo sentimento de desterro. Considera-se que os processos de identificação não se manifestam apenas com pessoas, mas também com o meio onde se convive. Estabelece uma correlação entre a relação idealizada que o paciente estabelecia com a "mãe terra" ao sentimento de exclusão característico da perda da ilusão edípica. Utilizando-se de uma "moda de viola", investiga-se como a angústia gerada na perda da identidade provocou somatizações e sofrimento. A superação desse estado se deu com o desenvolvimento da capacidade de pensar e simbolizar, atribuindo significados psíquicos às vivências afetivas...

From the clinical case of a rural inhabitant that migrates to an urban centre, we highlight the experience of inadequacy caused by the feeling of exile. It is considered that the identification processes do not manifest only with people but also with the environment where one lives. A correlation is established between the idealised relationship the patient had with their "motherland" with the feeling of exclusion, characteristic of the loss of oedipal illusion. Using "country songs", we've tried to investigate how the anxiety generated by the loss of identity caused somatisation and suffering. Overcoming this state occurred with the development of the ability to think and symbolise, assigning psychic meanings to affective experiences...

A partir de un caso clínico que describe un habitante rural que migra a un núcleo urbano, se destaca la vivencia de inadecuación causada por el sentimiento de destierro. Se considera que los procesos de identificación no se manifiestan sólo con las personas, sino también con el entorno donde se vive. El autor establece una correlación entre la relación idealizada que el paciente tenía con la "madre tierra" y el sentimiento de exclusión característico de la pérdida de la ilusión edípica. Usando "canciones folklóricas" se investigó cómo la angustia generada por la pérdida de identidad había provocado somatizaciones y sufrimiento. La superación de esta situación fue posible gracias al desarrollo de la capacidad de pensar y simbolizar, pudiendo asignar significados psíquicos a las experiencias afectivas...

Relación entre psoriasis y salud sexual: estudio en población chilena / Association between psoriasis and sexual health in a group of Chilean patients

Marco teórico: la asociación entre psoriasis y daño orgánico y psicológico está ampliamente descrita. Existen pocos estudios que la relacionen con la salud sexual. Objetivo: Establecer la relación entre cambios en la severidad de la psoriasis y la salud sexual en un grupo de pacientes chilenos. Pacientes y métodos: 47 pacientes chilenos portadores de psoriasis vulgar. Se realizó una encuesta epidemiológica, PASI y una entrevista llamada CSFQ-14, que evalúa la respuesta sexual. A los 3 meses de tratamiento, fueron reevaluados. Resultados: El PASI promedio disminuyó al tercer mes (p < 0.01). En los promedios de CSFQ-14, no hubo variación del total de la muestra (p > 0.05), pero al comparar sexos, tanto en día 1 como en día 3 fueron mayores en hombres (p < 0.01). Conclusión: En un primer estudio en población chilena, no se encontró relación entre cambios en la psoriasis y la salud sexual.

Background: The association between psoriasis and organic and mental damage is widely described. Few studies link this condition to sexual health. Objective: To establish the relationship between changes in the severity of psoriasis and sexual health in a group of Chilean patients. Patients and Methods:47 Chilean patients, submitted to an epidemiological survey, PASI, and an interview called CSFQ-14, which evaluates sexual response. After 3 months of treatment, they were re-assessed. Results: A decrease in average PASI was found after 3 months(p < 0.01). There was no change in the average CSFQ-14 scores of the total sample in the third month (p > 0.05). However, when comparing between sexes, either on day 1 or month 3, CSFQ-14 scores were higher in men (p < 0.01). Conclusion: In a first study using Chilean population, no relationship was found between changes in psoriasis and sexual health.

Factores subjetivos en la sexualidad, el contacto y la calidad de vida de pacientes con psoriasis / Psoriatic patients: subjective factors in sexuality, contact, and quality of life

La psoriasis es una enfermedad crónica inflamatoria de la piel que afecta la calidad de vida. Los cuestionarios utilizados para medir dicha afectación abordan la sexualidad a partir de preguntas generales y apelan a la respuesta consciente de los pacientes. La suposición de un mecanismo causa-efecto implícita en las preguntas impide explorar suficientemente los mecanismos inconscientes que relacionan las dificultades sexuales con la enfermedad. En este trabajo se describen los antecedentes acerca de calidad de vida y sexualidad y se desarrolla la perspectiva psicoanalítica acerca de sexualidad y psoriasis. En base a una muestra de 96 pacientes se aborda la relación entre: psoriasis, contacto sexual y distancias afectivas. Se mencionan cuatro casos clínicos y asociaciones obtenidas con la prueba de distancias afectivas. Por último, describiendo la relación entre los aspectos subjetivos asociados a fantasías inconscientes y la sexualidad, se señala su influencia en la calidad de vida de los pacientes.

Psoriasis: correlation between severity index (PASI) and systemic treatment / Psoriase: correlacao entre gravidade clinica (PASI) e qualidade de vida (DLQI) em pacientes avaliados antes e depois de tratamento sistemico

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ages andboth genders. The impact of the disease on quality of life is greater among patients with moderate to severe psoriasis. OBJECTIVE: to establish a correlation between the psoriasis area and severity index (PASI) and theDermatology Life Quality Index (DLQI) based on a quality of life questionnaire adapted to the Brazilian contextfor patients with plaque psoriasis before and after systemic treatment. METHODS: This was a cross-sectional, descriptive study of psoriasis patients who did not undergo treatment or who manifested clinical activity of the disease. Patients were evaluated according to the PASI and the quality of life questionnaire adapted to theBrazilian context before and 60 days after systemic treatment. RESULTS: Thirty-five patients participated in thestudy. Twenty-six were men, with a mean age of 46 years. There was no correlation between the PASI and thequality of life questionnaire adapted to the Brazilian context, but there was a correlation between the PASI andsome items of the quality of life questionnaire adapted to the Brazilian context, such as jobs involving public contact. CONCLUSION: The non-correlation between the PASI and the quality of life questionnaire adapted to the Brazilian context in this work may be associated with a history of chronic disease, which implies greater acceptance of the illness, or may be related to the low income and social status of the patients studied. The correlationobserved among patients with careers involving public contact suggests that some professions are more impacted by the disease. It may be necessary to adapt the quality of life questionnaire to patients with a low income andcultural and social limitations. The small sample size (n=35 patients) and the short follow-up period of 60 dayswere some of the limitations of this work. .

FUNDAMENTOS: Psoríase é doença inflamatória crônica da pele que afeta pacientes de todas as idades eambos os gêneros. O impacto negativo na qualidade de vida é mais importante naqueles pacientes com psoríasemoderada a grave. OBJETIVO: Correlacionar o índice de gravidade e extensão da psoríase e o índice de qualidadede vida, segundo questionário de qualidade de vida adaptado ao Brasil, em pacientes de psoríase em placas antes e depois de tratamento sistêmico. MÉTODO: Estudo transversal, descritivo, de pacientes de psoríase, virgens detratamento ou em atividade clinica, submetidos a avaliação do índice de gravidade e extensão da psoríase e aoquestionário de qualidade de vida adaptado ao Brasil antes e após 60 dias de tratamento com medicação sistêmica. RESULTADOS: Trinta e cinco pacientes foram estudados, 26 homens, com idade média de 46 anos. Não houvecorrelação entre índice de gravidade e extensão da psoríase e questionário de qualidade de vida adaptado aoBrasil. Mas, houve correlação entre índice de gravidade e extensão da psoríase e itens do questionário de qualidade de vida adaptado ao Brasil, tal como "atividade profissional com público". CONCLUSÃO: A não correlação entre índice de gravidade e extensão da psoríase e questionário de qualidade de vida adaptado ao Brasil nessainvestigação pode estar relacionada com história crônica de psoríase, o que implicaria em melhor aceitação dadoença ao longo do tempo ou às condições sociais e de baixa renda dos pacientes estudados. A correlação observada entre aqueles com atividade pública sugere que algumas profissões podem sofrer maior impacto da enfermidade. ...

Translation into Brazilian portuguese and validation of the psoriasis family index / Tradução e validação do instrumento índice de qualidade de vida para familiares de pacientes com psoríase para o português falado no Brasil

Psoriasis Family Index is a quality of life instrument for family members of patients with psoriasis developed in English. The aims of this study were to translate the Psoriasis Family Index into Brazilian Portuguese, culturally adapt it and verify its reliability and validity. The study followed these two steps: 1) Translation, linguistic and cultural adaptation, 2) Validation. The translated Psoriasis Family Index showed high internal consistency and high test-retest reliability, confirming its reproducibility. The Portuguese version of the Psoriasis Family Index was validated for our population and can be recommended as a reliable instrument to assess the QoL of family members and partners of patients with psoriasis.

Psoriasis Family Index é um instrumento para aferição da qualidade de vida em familiares de pacientes com psoríase, desenvolvido em língua inglesa. O objetivo deste estudo é traduzir o Psoriasis Family Index para o Português, adaptá-lo culturalmente e determinar sua confiabilidade e validade. Foi realizado em duas etapas: 1) tradução, adaptação cultural e linguística e 2) validação. O Psoriasis Family Index traduzido demonstrou alta consistência interna e alta confiabilidade de teste e reteste, confirmando sua reprodutibilidade. A versão brasileira do Psoriasis Family Index foi validada para nossa população e pode ser recomendada como uma ferramenta na avaliação da influência da psoríase na família dos pacientes.

Assessment of the quality of life of pediatric patients at a center of excellence in dermatology in southern Brazil / Avaliação da qualidade de vida dos pacientes pediátricos de um centro de referência em dermatologia no sul do Brasil

BACKGROUND: Skin diseases cause negative impact on the emotional state, social relationships and daily activities, due to the stigma caused by the appearance of the lesions. OBJECTIVE: This study aimed to assess the quality of life of pediatric patients with skin diseases attending a dermatology service, compare the scores obtained among the dermatoses found in the sample and associate them to the variables, in addition to observing how the skin disease specifically affects quality of life. METHODS: Cross-sectional study, with patients between 5 and 16 years attending the Dermatology Service of the University of Health Sciences of Porto Alegre, Brazil, between July 2010 and February 2011. The data collection instruments were the Children's Dermatology Life Quality Index questionnaire and the AUEQI questionnaire. RESULTS: A total of 161 patients were interviewed, with mean age of 9,66 years. The main dermatoses were atopic dermatitis (29.8%), warts (13%) and molluscum contagiosum (7.5%). Chronic diseases (73.9%) were the most prevalent. The overall mean Children's Dermatology Life Quality Index score was 5.01 for chronic dermatoses and 2.07 for acute illnesses, indicating a compromised quality of life among chronically ill patients. The comparison between the scores obtained with the AUEQI scale and the Children's Dermatology Life Quality Index scores indicates that the overall quality of life is less affected than the specific quality of life related to the dermatosis. CONCLUSIONS: The data presented reinforce how important it is that the patients, their families and caregivers understand the symptoms, triggers and treatment of the skin disease in question. This information facilitates adherence to the treatment and justifies the conduct adopted by the dermatologist.

FUNDAMENTOS: Doenças dermatológicas, em razão dos estigmas pela aparência das lesões, são fonte de impacto negativo no estado emocional, relações sociais e atividades cotidianas. OBJETIVOS: Este estudo objetiva avaliar a qualidade de vida nos pacientes dermatológicos pediátricos em um centro de referência em dermatologia, comparar os índices de qualidade de vida entre as dermatoses e associá-los às variáveis, além de avaliar de que forma as dermatoses afetam a qualidade de vida especificamente. MÉTODOS: Estudo analítico transversal, pacientes entre 5 e 16 anos, do Serviço de Dermatologia da Universidade Federal de Ciências da Saúde de Porto Alegre, entre julho de 2010 e fevereiro de 2011. Instrumentos utilizados: questionário Índice Pediátrico de Qualidade de Vida em Dermatologia e escala AUQEI. RESULTADOS: Um total de 161 pacientes, média de idade de 9,66 anos. As principais dermatoses foram dermatite atópica (29,8%), verrugas vulgares (13%) e molusco contagioso (7,5%). Doenças crônicas (73,9%) foram mais prevalentes. A média do Índice Pediátrico de Qualidade de Vida em Dermatologia de 5,01 para dermatoses crônicas, e de 2,07 em agudas, indicando maior comprometimento da qualidade de vida entre os pacientes cronicamente enfermos. A comparação entre os escores obtivos com a escala AUEQI e o Índice Pediátrico de Qualidade de Vida em Dermatologia indicam que a qualidade de vida global é afetada com menor intensidade do que a relacionada especificamente à dermatose. CONCLUSÃO: Os dados obtidos reforçam a importância do entendimento dos sintomas, desencadeantes e da terapêutica da dermatose em questão pelos pacientes, por seus familiares e por seus cuidadores. Tais infomações facilitam a aderência ao tratamento e justificam a conduta adotada pelo dermatologista.

Assessment of the quality of life of pediatric patients with the major chronic childhood skin diseases / Avaliação da qualidade de vida em pacientes pediátricos com as principais dermatoses crônicas da infância

BACKGROUND: The skin is the primary interface of the human being with the external environment and the presence of skin diseases can have substantial effects on the quality of life. OBJECTIVE: This study aims to make a comparative evaluation of the quality of life of pediatric patients with atopic dermatitis, psoriasis and vitiligo and correlate the findings with the total body surface and the areas with the disease exposed to view. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, aged between 5 and 16 years, who were asked to answer the Children's Dermatology Life Quality Index (CDLQI) questionnaire. A dermatological examination for the measurement of total body surface affected by the disease was performed. RESULTS: The three groups showed an impaired quality of life. Patients with atopic dermatitis and psoriasis showed a significantly greater impact on the QoL than the group with vitiligo. There is a trend towards impaired quality of life in patients from the three groups of dermatoses, which is related to increments in both the total affected area and affected area exposed to view (r = 0.428 and p <0.001, r = 0.381 and p <0.001, respectively). CONCLUSION: The assessed children had impaired quality of life. However, there is a significantly greater impact in the groups with atopic dermatitis and psoriasis than in the group with vitiligo. This may be due to lack of symptoms in vitiligo and the fact this group presented a statistically smaller affected body surface than the other two groups.

FUNDAMENTOS: A pele é a principal interface do ser humano com o meio externo e a presença de doenças cutâneas pode levar a repercussões importantes na qualidade de vida. OBJETIVOS: O presente estudo tem como objetivo fazer uma avaliação comparativa entre a qualidade de vida dos pacientes pediátricos com dermatite atópica, vitiligo e psoríase e correlacioná-la à superfície corporal total e às áreas expostas à visualização acometidas pela doença. MÉTODOS: Amostra composta por 118 pacientes com dermatite atópica, vitiligo e psoríase na faixa etária entre 5 a 16 anos para a aplicação do questionário Índice de Qualidade de Vida para Dermatologia em Crianças (CDLQI). Realizado exame dermatológico para a aferição da superfície corporal total acometida pela doença. RESULTADOS: Os três grupos de pacientes pediátricos demonstraram ter redução na qualidade de vida. Os pacientes com dermatite atópica e psoríase apresentaram um impacto na QoL significativamente maior que o grupo com vitiligo. Há uma tendência na redução da qualidade de vida dos pacientes dos três grupos de dermatoses relacionado ao aumento tanto da superfície total quanto da superfície exposta à visualização (r=0,428 e p<0,001; r=0,381 e p<0,001, respectivamente). CONCLUSÃO: As crianças avaliadas com dermatite atópica, psoríase e vitiligo apresentaram redução na qualidade de vida. Porém, há um impacto significativamente maior nos grupos de pacientes com dermatite atópica e psoríase em relação ao grupo com vitiligo. Este fato pode dever-se a ausência de sintomas no vitiligo e ao grupo ter apresentado uma superfície corporal comprometida estatisticamente menor que outros dois grupos.

Comparação entre questionários de qualidade de vida e sua correlação com a evolução clínica de pacientes com psoríase / Comparison of quality of life questionnaires and their correlation with the clinical course of patients with psoriasis

FUNDAMENTO: A psoríase é uma dermatose inflamatória crônica caracterizada por lesões eritemato-descamativas que atingem extensas áreas da pele, comprometendo a qualidade de vida dos pacientes por interferir na sua vida pessoal, no relacionamento social e nas atividades diárias. O tratamento permite um bom controle, mas a impressão do paciente, quase sempre, é pouco valorizada. OBJETIVOS: Avaliar a qualidade de vida de pacientes psoriáticos, verificar se há correlação desta com melhoras clínicas e se há equivalência entre dois questionários de qualidade de vida. MÉTODOS: Foram incluídos no estudo pacientes maiores de 18 anos que estavam no início ou troca de tratamento no ambulatório de psoríase do Hospital de Clínicas da Unicamp. Eles responderam dois questionários de qualidade de vida (Psoriasis Disability Index e Dermatological Life Quality Index), até completar 180 atendimentos, para avaliar se haveria correlação entre os questionários. Receberam também um índice clínico (Índice de Área e de Severidade da Psoríase) no tempo inicial da pesquisa e nos retornos subsequentes. RESULTADOS: A pesquisa foi realizada com 138 pacientes (76 homens, idade média de 50 anos). Observou-se correlação entre os questionários aplicados e o índice clínico, mostrando que alterações clínicas se refletem na qualidade de vida, e que há equivalência entre os questionários. CONCLUSÃO: Constatou-se que a maioria dos pacientes atendidos no ambulatório tem apresentado melhora clínica e da qualidade de vida e que há equivalência entre os questionários de qualidade de vida.

BACKGROUND: Psoriasis is a chronic inflammatory dermatosis characterized by erythematous, scaly lesions covering extensive areas of the skin and negatively affecting patients' quality of life by interfering in their personal life, social relationships and routine activities. Treatment offers reasonable control of the condition; however, little importance is generally given to the patient's impression. OBJECTIVES: To evaluate the quality of life of patients with psoriasis, to verify whether there is a correlation between quality of life and clinical improvement and to compare two quality of life questionnaires and evaluate their equivalence. METHODS: Patients over 18 years of age attending the psoriasis outpatient clinic at the Teaching Hospital of the University of Campinas (UNICAMP), who were either initiating treatment or changing to a new form of treatment, were included in the study. Patients answered two quality of life questionnaires (the Psoriasis Disability Index and the Dermatological Life Quality Index) up to a total of 180 consultations to evaluate whether there is a correlation between the questionnaires. Patients were also rated using a clinical index (Psoriasis Area and Severity Index) at baseline and at follow-up visits. RESULTS: The study involved 138 patients (76 men; mean age 50 years). A correlation was found between the questionnaires and the clinical index, showing that clinical changes are reflected in quality of life. The two questionnaires were found to be equivalent. CONCLUSION: It was found that both clinical condition and quality of life improved in the majority of patients receiving care at this outpatient clinic and that the quality of life questionnaires are equivalent.