Factors That Affect Quality of Life in Psoriasis

Appearance-related factors seem to weigh most heavily on adolescent patients with psoriasis.

Health-related quality of life in patients with psoriasis is affected by several factors, especially appearance-related concerns, according to results of an in-depth qualitative study published in the British Journal of Dermatology.

Adolescent patients with psoriasis and their parents were recruited from the Danish National Birth Cohort, a summer school sponsored by the Danish Psoriasis Association, and a specialized dermatology hospital outpatient clinic.

Overall, 36 semistructured interviews were conducted in adolescents age 12 to 17 years who had psoriasis (n=18), their parents (n=14, of whom 12 were mothers), and healthcare professionals who work in the field (n=4).

Separate interviews were developed for adolescents, for parents, and for healthcare professionals. Participants were informed that the investigators did not seek correct responses, but instead were interested in hearing about their personal experiences and thoughts.

The 18 adolescents and their parents were interviewed between June 2015 and November 2016. The healthcare professionals (2 dermatology nurses, 1 clinical dermatologist, and 1 hotline counselor) were interviewed either face to face (n=3) or by telephone (n=1).

The analysis identified 6 key themes and subthemes that are reflective of physical, psychological, and social aspects of the disease: (1) physical symptoms (mostly itching and flaking); (2) feeling different; (3) psoriasis-related worry about the future; (4) increased attention (eg, being stared at and asked questions about their appearance, as well as teasing and bullying); (5) attempts to conceal skin; and (6) treatment-related frustrations and worry.

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Overall, social support, particularly from family and close friends, the ability to speak openly about psoriasis, and methods of normalization (eg, meeting others with the disorder) seemed to be protective mechanisms. The localization of plaques appeared to be quite important, and adolescents with psoriasis on visible parts of their body generally reported more impairment. Moreover, older adolescents (15-17 years of age) reported more impairment in their daily lives than did younger adolescents (12-14 years of age).

The investigators concluded that the current study provides a framework for understanding and help identifying health-related quality of life issues of significance to adolescents with psoriasis, which may help clinicians develop a psoriasis-specific measure of health-related quality of life in this patient population.


Randa H, Lomholt JJ, Skov L, Zachariae R. Health-related quality of life in adolescents with psoriasis: an interview-based study [published online January 8, 2018]. Br J Dermatol. doi: 10.1111/bjd.16326