title: Clinical and therapeutic evaluation of patients with moderate to severe psoriasis in Spain: the secuence study.
abstract: BACKGROUND
  Evaluation of disease severity is considered essential in the optimal management of psoriasis.
  
  
  OBJECTIVE
  To describe the clinical characteristics and therapeutic profile of patients with moderate to severe psoriasis in Spain and to assess the impact of the disease on the patients' quality of life.
  
  
  METHODS
  This was an observational, cross-sectional study carried out in 90 dermatology units in Spain in 2009. We included 442 patients diagnosed with moderate to severe psoriasis who had started treatment with systemic agents, phototherapy, and/or topical treatments between 2004 and 2006.
  
  
  RESULTS
  More severe psoriasis was significantly associated with the following: longer disease duration; higher prevalence of concomitant disease; greater involvement of the nails, scalp, flexures, palms, and soles; and poorer quality of life. In the 5 years before the start of the study, 68% of the patients had received conventional systemic treatments, 39.1% biologic agents, and 22.3% phototherapy. At present, 57.5% of the patients are being treated with biologic agents, 32.6% with conventional systemic treatments, and 11% with phototherapy.
  
  
  CONCLUSIONS
  Severity of psoriasis was associated with a marked impact on quality of life. Regardless of disease severity, psychiatric comorbidity was the strongest predictor of poor quality of life. On average, patients had received other treatments, such as conventional systemic treatments or phototherapy, for more than 2 years before switching to biologic agents for the first time.
authors.affiliation: Departamento Dermatología, Hospital Infanta Leonor, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Hernánz
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Regaña
authors.forename: R
authors.initials: R
authors.lastname: Izu
authors.forename: V
authors.initials: V
authors.lastname: Mendiola
authors.forename: C
authors.initials: C
authors.lastname: García-Calvo
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain