title: Lesions on the back of hands and female gender predispose to stigmatization in patients with psoriasis.
abstract: BACKGROUND
  Psoriasis vulgaris is characterized by disfiguring and stigmatizing skin lesions. The links among lesions distribution, severity, and stigmatization remain unclear.
  
  
  OBJECTIVE
  We sought to investigate if the involvement of visible and sensitive areas is linked to stigmatization.
  
  
  METHODS
  In all, 115 patients with psoriasis vulgaris were assessed for disease severity, skin lesions distribution, itch, and stigmatization using the Feelings of Stigmatization Questionnaire. Quality of life was assessed with the Dermatology Life Quality Index and the World Health Organization Quality of Life-BREF.
  
  
  RESULTS
  The localization of psoriatic lesions on the back of hands was related to higher stigmatization levels (P = .011, total score of the Feelings of Stigmatization Questionnaire), but not the involvement of nails, the palms, the face, or the genital area nor overall disease severity. All patients reported some level of stigmatization, regardless of the localization of lesions and type of psoriasis. Higher levels of stigmatization characterized patients who claimed not to be able to hide their lesions by clothing (P = .025), women (P = .001), and the unemployed (P = .004). Stigmatization was the strongest predictor of quality of life impairment.
  
  
  CONCLUSIONS
  Only hospitalized patients were included.
  
  
  CONCLUSIONS
  Psoriatic lesions on the back of hands are debilitating and warrant effective treatment. Special attention should be paid to female patients, who are more sensitive to stigmatization.
authors.affiliation: Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Marlena
authors.initials: M
authors.lastname: Hawro
authors.affiliation: Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Maurer
authors.affiliation: Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Weller
authors.affiliation: Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Romuald
authors.initials: R
authors.lastname: Maleszka
authors.affiliation: Psychodermatology Department, Clinical Immunology and Microbiology, Medical University of Łódź, Łódź, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Zalewska-Janowska
authors.affiliation: Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kaszuba
authors.affiliation: Psychodermatology Department, Clinical Immunology and Microbiology, Medical University of Łódź, Łódź, Poland.
authors.forename: Zofia
authors.initials: Z
authors.lastname: Gerlicz-Kowalczuk
authors.affiliation: Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: tomasz.hawro@charite.de.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hawro
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001828:Body Image; D004522:Educational Status; D005260:Female; D006229:Hand Dermatoses / Q000209:etiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity; D011537:Pruritus / Q000209:etiology; D011565:Psoriasis / Q000209:etiology / Q000523:psychology*; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D012737:Sex Factors; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014478:Unemployment
keywords: psoriasis; psychodermatology; quality of life; skin lesions; social rejection; social stigma; stigmatization