title: Increased severity of itching, pain, and scaling in psoriasis patients is associated with increased disease severity, reduced quality of life, and reduced work productivity.
abstract: BACKGROUND
  Psoriasis patients report that this disease can impact on their health-related quality of life (HR-QoL) and work productivity. It is important to understand how this is influenced by the clinical characteristics of psoriasis such as symptom severity. Common symptoms include itching, pain, and scaling but the psychosocial impact these features have on patients is not well understood.
  
  
  OBJECTIVE
  To explore the impact of psoriasis symptoms (itching, pain, and scaling) on HR-QoL and work productivity.
  
  
  METHODS
  Data were extracted from the Adelphi 2011 and 2013 Psoriasis Disease Specific Programmes - two real world surveys of US dermatologists and their psoriasis patients.  HR-QoL was measured using the Dermatology Life Quality Index (DLQI) and EuroQOL 5-Dimension Health Questionnaire (EQ-5D). Work productivity loss was measured by the Work Productivity and Activity Impairment (WPAI) questionnaire. The impact of symptom severity (none, mild, moderate/severe) for itching, pain, and scaling on DLQI, EQ-5D, and WPAI scores were examined, controlling for differences in demographics and co-morbidities.
  
  
  RESULTS
  Patient mean age was 44 years and 55% were male. Moderate/severe itching, pain, and scaling were experienced by 33%, 13%, and 41% of patients, respectively. Controlling for differences in demographics and co-morbidities, increased symptom severity was associated with reduced HR-QoL. Accordingly, EQ-5D scores decreased with itching severity (moderate/severe vs. none: -0.07; 95% confidence interval [CI] =-0.09, -0.04), whereas DLQI scores increased (moderate/severe versus none: 4.9; CI = 3.9, 5.9) (both p&lt;0.05). WPAI scores increased with itching severity, indicating increased work productivity loss (moderate/severe versus none: 17.6, CI = 11.8, 23.5, p&lt;0.05). The same pattern was observed for pain and scaling.
  
  
  CONCLUSIONS
  Among the patients studied, increased severity of psoriasis-related itching, pain, and scaling was associated with reduced health-related QoL and work productivity.
authors.affiliation: University Hospitals Case Medical Center.
authors.forename: N J
authors.initials: NJ
authors.lastname: Korman
authors.forename: Y
authors.initials: Y
authors.lastname: Zhao
authors.forename: J
authors.initials: J
authors.lastname: Pike
authors.forename: J
authors.initials: J
authors.lastname: Roberts
authors.forename: E
authors.initials: E
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D018450:Disease Progression; D004526:Efficiency; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000209:etiology; D010147:Pain Measurement; D011379:Prognosis; D011537:Pruritus / Q000175:diagnosis* / Q000209:etiology; D011565:Psoriasis / Q000150:complications* / Q000175:diagnosis; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires