title: Effectiveness of interdisciplinary vs. dermatological care of moderate-to-severe psoriasis: a pragmatic randomised controlled trial.
abstract: Psychiatric morbidity is frequent in patients with psoriasis. We compared the effectiveness of dermatological vs. interdisciplinary dermatological and psychiatric care for psoriasis. Adults with moderate-to-severe psoriasis were randomly allocated to dermatological (n = 24) or interdisciplinary care (n = 23) and treated accordingly. Primary endpoint was the mean change in Dermatology Life Quality Index (DLQI) at 6 months. Data was analysed by intention-to-treat. Mean ± SD change in DLQI was 7.5 ± 7.3 and 10.5 ± 9.9 after 6 months of dermatological and interdisciplinary care, respectively (p = 0.27). At baseline, 10 patients in the interdisciplinary treatment group (43%) had at least one psychiatric disorder. These patients showed significantly better DLQI response (DLQI change 14.8 ± 9.7) than patients receiving dermatological care only (p = 0.03). Ninety percent of psoriasis patients with DLQI scores exceeding psoriasis area and severity index (PASI) scores had comorbid psychiatric disease. Although psychiatric co-treatment is not generally required for patients with moderate-to-severe psoriasis, those patients with higher DLQI scores than PASI scores might benefit from interdisciplinary care.
authors.affiliation: Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, DE-01307 Dresden, Germany. jochen.schmitt@uniklinikum-dresden.de, jochen.schmitt@tu-dresden.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.forename: Gottfried
authors.initials: G
authors.lastname: Wozel
authors.forename: Marlene
authors.initials: M
authors.lastname: Garzarolli
authors.forename: Antje
authors.initials: A
authors.lastname: Viehweg
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.forename: Karolina
authors.initials: K
authors.lastname: Leopold
mesh_terms: D000367:Age Factors; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010348:Patient Care Team; D011565:Psoriasis / Q000453:epidemiology / Q000628:therapy*; D011788:Quality of Life; D012720:Severity of Illness Index; D012737:Sex Factors