Self-reported psoriasis severity and quality of life assessment at Comano spa.

The relationship between quality of life (QoL) and skin lesion improvement due to psoriasis treatment has been recently underlined. Our objective was to study the self-reported disease severity reduction and QoL during spa treatments and identify predictors of psoriasis improvement. Patients were assessed before and after spa treatment with a disease-specific QoL questionnaire (Skindex-17) and self-administered psoriasis area and severity index (SAPASI). Their correlations were tested. Factors predicting a reduction in Skindex-17 or in SAPASI score were evaluated through regression analysis. Significant mean overall reductions in SAPASI (27%) and Skindex-17 scores (psychosocial: 6%; symptoms: 2%) were achieved. However, 51% of patients reporting SAPASI improvement also reported a worsened QoL. Pearson's correlation between the SAPASI and Skindex-17 scores was poor (r=0.26 for SAPASI-symptoms and r=0.40 for SAPASI-psychosocial). Logistic regression analysis identified the age of psoriasis onset before 30 years (OR=3.81, 95% CI 1.22-11.95, p=0.02) and a basal Skindex-17 symptoms value greater than 5 (OR=3.37, 95% CI 1.12-10.08, p=0.03) as predictive of both SAPASI and Skindex-17 score reductions. Age-of-onset-based stratification identifies the subset most likely to respond to spa treatment. Combining the Skindex-17 with SAPASI provides a more comprehensive patient-centered assessment. We recommend this assessment for psoriasis patients undergoing spa treatment.

Effectiveness of an empowerment-based intervention for psoriasis among patients attending a medical spa.

There is increasing interest in the management of chronic diseases through patient self-efficacy procedures. Very few studies are available assessing the efficacy of empowerment-based educational interventions for psoriasis patients. To evaluate an educational programme for increasing empowerment, in a spa setting (Comano, Italy). An educational intervention with pre-post test for empowerment evaluation was employed with patients assigned either to a control (balneotherapy) or an experimental group (balneotherapy plus empowerment-based educational interventions) (quasi-experimental). The outcome measures were self-reported scores through validated tools for empowerment, severity of disease and quality of life, assessed before and after a single two-hour empowerment-based educational intervention. A total of 136 patients completed the study (control n. 49; experimental n. 87). The experimental group reported higher levels of empowerment with improved knowledge about the disease as compared to the control group. After the balneotherapy, both groups reported a positive effect on quality of life. Patients' characteristics linked to intervention effectiveness were identified. A single empowerment-based educational intervention has the potential to increase psoriasis patients' empowerment by means of increased knowledge. It is advisable to promote it as a standardized, low-cost practice for motivated patients.

Efficacy of a single educative intervention in patients with chronic plaque psoriasis.

BACKGROUND: An effective patient-physician relationship is important in the management of psoriatic patients. OBJECTIVE: Our purpose was to investigate the efficacy of an educational intervention for patients with psoriasis in improving disease knowledge and attitude towards physicians and systemic treatments. METHODS: The intervention consisted of a single, 2-hour educational programme conducted either by a dermatologist or by a dermatologist and a psychologist. Information on psoriasis and its treatment was given. A questionnaire concerning knowledge about psoriasis was administered before and after the programme, and after 6 months. RESULTS: 123 patients were enrolled. They reported a high degree of satisfaction with the intervention, improvement in knowledge about the disease and a better attitude towards therapy. After 6 months a better knowledge about the disease and a higher attitude to treatment were retained. CONCLUSIONS: A single educational intervention may be helpful in improving psoriasis knowledge and give psychological relief to patients.

Quality of life of psoriasis patients before and after balneo -- or balneophototherapy.

PURPOSE: An observational prospective study was conducted to study the effects of hypotonic spa-water baths and narrowband ultraviolet B therapy given alone or in combination for treatment of moderate-severe psoriasis. MATERIALS AND METHODS: TWO TREATMENTS WERE ANALYSED: 2 weeks of balneotherapy followed by ultraviolet-B (UVB) 311-nm phototherapy (BPT) or 2 weeks of daily bath treatments of Comano water alone (BT). One hundred and eleven adult patients with moderate to severe chronic plaque psoriasis were enrolled. Quality of life (QoL) questionnaires {36-item Short Form of the Medical Outcomes Study questionnaire (SF-36) and Skindex-29} were administered at baseline and 2 months from the end of therapy. The self-administered Psoriasis Area Severity Index (SAPASI), and the General Health Questionnaire (GHQ)-12 (to assess clinical severity and psychological distress, respectively) were also recorded at the same time-periods. RESULTS: SAPASI was significantly reduced from 15.2 to 8.7 in BPT group and 11.6 to 7.8 in BT. A decrease of greater than 50% after therapy in SAPASI_50 score was reached by 42% and 37% of patients in the BPT and BT groups, respectively. At follow-up, both groups had better scores on all SF-36 scales (with statistically significant improvement in social functioning and mental health in the BPT group) and in all Skindex-29 scales. A statistically significant reduction of GHQ-12 positive cases was observed in the BPT group. CONCLUSION: Comano spa-water alone or in combination with phototherapy had beneficial therapeutic effects on patients with psoriasis. Although our observational study design prevents us from making meaningful comparisons between the 2 interventions, the combination of balneo and phototherapy seems to improve QoL and lessen clinical severity, and reduced the proportion of GHQ-12 positive cases.