Analysis of Quality of Life in Relation with Physical and Psychological Morbidity in Patients of Psoriasis

Vivek Nimbark¹, Devanshi Nimbark^1*, Hita Mehta², Bharat Panchal³

¹Consultant, Umang Skin, Hair and Laser Clinic, Vardhaman Arize, Kalubha Road, Devbagh, Bhavnagar-364001, Gujarat, India
²Professor and Head, Department of Dermatology, Venereology and Leprosy, Skin OPD, New OPD Building, Sir T Hospital, Jail Road, Bhavnagar-364001, Gujarat, India
³Professor and Head, Department of Psychiatry, Psychiatry OPD, New OPD Building, Sir T Hospital, Jail Road, Bhavnagar-364001, Gujarat, India

*Correspondence author: Devanshi Nimbark, MD, DVL, Consultant, Umang Skin, Hair and Laser Clinic, Vardhaman Arize, Kalubha Road, Devbagh, Bhavnagar-364001, Gujarat, India; Email: [email protected]

Citation: Nimbark V, et al. Analysis of Quality of Life in Relation with Physical and Psychological Morbidity in Patients of Psoriasis. J Dermatol Res. 2025;6(1):1-8.

Copyright^© 2025 by Nimbark V, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Psoriasis Area and Severity Index (PASI) score.

Table 2: Statistically significant (P<0.05) with the odds ratio.

Table 3: The findings of components of metabolic syndrome.

Table 4: Data with chi-square test.

Discussion

Psoriasis is a systemic inflammatory disease, which involves proinflammatory cytokines such as tumor necrosis factor-α and interleukin-6 that are also known to contribute to the features of Metabolic Syndrome (MS) such as hypertension, dyslipidaemia and insulin resistance. Several observational studies have recently demonstrated that, psoriasis is associated with systemic disorders such as cardiovascular disease, MS, carcinomas, chronic obstructive pulmonary diseases, inflammatory bowel diseases, depression and osteoporosis. Chronic Th-1 and Th-17-mediated inflammation with dysregulation of cytokines for e.g. tumor necrosis factor-α and interleukin-6, not only promotes epidermal hyperplasia in psoriasis, but may also antagonize insulin signalling, alter adipokine expression, mediate insulin resistance and obesity. Overlapping inflammatory pathways and genetic susceptibility may be a potential biologic link underlying this association. Immune pathways which drive psoriasis are also prominent disease mediators for atherosclerosis and thrombosis, thus we can say psoriasis and metabolic syndrome are considered as branches of the same tree. Psoriasis not only impacts physical aspects but also affects psychological aspects of the patient. Owing to chronic nature of the disease and distribution of skin lesion over the exposed parts of the body, psoriasis has a profound effect on the mental status of the patient. Thus, evaluation of psoriasis based on clinical severity alone would not suffice, rather a more holistic approach considering the quality of life of the patient, psychological assessment along with clinical treatment modalities would be more helpful. Many studies have been carried out till now regarding the association of metabolic syndrome and its components with psoriasis. In our study we observed a higher prevalence of metabolic syndrome in patients of psoriasis than control [26.25% vs 12.5%, Odds Ratio (OR) 2.49] which is similar to other studies carried out by Kothiwala, et al., [42.1% vs 21.4% or 2.67], Gisondi, et al., [30.1% vs 20.6% or 1.65], Nisa and Qazi [28% vs 6% or 6.09] and Love, et al., [40% vs 23% or 2.16] [2-5].

No association was observed between metabolic syndrome and duration of psoriasis. Such findings were observed by Gisondi, et al., which included patients of psoriasis of duration longer than 6 months [3]. Kothiwala, et al., observed similar findings along with the relationship of severity of psoriasis and metabolic syndrome in the cross-sectional study, of 140 patients of psoriasis and 140 controls [2]. Sommer, et al., carried out a hospital-based study in Germany noted that hospitalized treatment-resistant chronic plaque psoriasis with greater body surface area involvement had direct correlation with the metabolic syndrome as compared to controls [6]. Similar trend of increase in metabolic syndrome, along with the increase in severity of psoriasis was observed by Langan, et al., [7]. Increased prevalence of metabolic syndrome in patients of psoriasis especially with high PASI score (>10) was observed by Nisa and Qazi [4]. However, not all the studies carried out have found a positive association between the metabolic syndrome and psoriasis. Pereira, et al., in a study on 77 patients with chronic plaque psoriasis from Mumbai, India and Lakshmi, et al., in a study of 40 patients with chronic plaque psoriasis from South India were not able to demonstrate any significant association between metabolic syndrome and psoriasis [8,9].

Components of metabolic syndrome were also the focus of our study and they were compared between the cases and controls. In our study, on analyzing the physical parameters, systolic blood pressure was significantly impaired in the cases as compared to controls (P = 0.0004). Also, the serum triglyceride levels and fasting blood sugar levels were significantly affected with (P = 0.0005) and (P = 0.0018) respectively. Thus, linear relation was observed between psoriasis, diabetes and hypertension (Table 2). Our findings were further substantiated by many other studies [2,8,10]. We also observed association of dyslipidemia, that is raised triglyceride levels in psoriasis patients as compared to controls (Table 2) alike to the study of Nisa and Qazi [4]. Langan, et al., also noted the association of obesity along with hypertension, raised fasting blood sugar and severity of psoriasis [7].

Psychological morbidity in our study was analyzed by 2 questionnaires, Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS). There are various studies carried out, mentioning the importance of quality of life in patients of psoriasis. A review article by Bhosle, et al., mentions different tools that can be used for psoriasis for quality of life such as Psoriasis Index of Quality of life (PSORIQol), Psoriasis Life Stress Inventory (PLSI), Psoriasis Disability Index (PDI) [11]. A study which included 217 patients of psoriasis by Gupta, et al., had a significant finding of 9.7% of patients reporting a wish to be dead and 5.5% reported active suicidal ideation at the time of the study [12]. No such suicidal tendencies or death wish were noted in case of our study.

On evaluating DLQI, 35% of cases of psoriasis had impaired Quality of Life (QOL) in comparison to 2.5% of controls. In cases, the major factors contributing to impairment of QOL were their symptoms (itching, burning) and feelings (embarrassment, helplessness) while the least contributing was about their personal relationships. Overall, on comparing the psychological assessment of cases and controls, impairment of QOL was highly significant (P = <0.0001) (Table 2,4). A linear correlation between PASI and DLQI was observed in our study as depicted in Fig. 2. Similar findings were observed by Rakhesh SV, et al., in a study of 50 patients carried out in South India [13]. They observed that clinical PASI scores correlated significantly with the overall Physical Disability (PDI), individual aspects of the PDI (except the treatment-related activities) and the measurement of stress incurred (PLSI).

A study of 100 patients of psoriasis 21-60 years of age, was carried out by Tee, et al., in Singapore. Anxiety and depression were quantified in them by HADS, where they noted an anxiety disorder in 17%, while a depressive disorder in 15% [14]. In our study, we noted anxiety and depressive disorder in 16.25% and 18.75% respectively on analyzing HADS of cases of psoriasis. While anxiety and depressive disorder were not at all observed (0%) in controls (Table-2,4).

Limitations

The study’s cross-sectional nature limits its ability to establish causal relationships between psoriasis, metabolic syndrome and psychological morbidity. Longitudinal studies would be needed to track the progression of these associations over time. A larger sample size could provide more robust data and enhance the generalizability of the findings, particularly across diverse populations.

The exclusion of patients who had been on systemic therapy within the last three months (e.g., acitretin, cyclosporine, methotrexate) may have introduced bias, as these treatments could potentially affect metabolic parameters and psychological well-being. While this exclusion criterion may lead to a slight selection bias—potentially excluding patients with severe psoriasis who are more likely to be on systemic therapy—it does not invalidate the study’s core findings. Instead, it enhances the ability to assess psoriasis-related morbidity independent of treatment effects. Future longitudinal studies that include treated patients with appropriate adjustments for systemic therapy effects could further validate these associations.

While the study controlled for certain factors like age and sex, other confounders such as socioeconomic status, comorbidities or lifestyle factors (e.g., diet, physical activity) were not explicitly controlled for, which may influence the study outcomes.

Conclusion

Psoriasis has a quite detrimental effect on patients and can make them psychologically handicap. Our study is unique in the way that we have compared patient’s physical and psychological aspects to controls. Result being, overall prognosis of patients can be well explained.

The study concludes that psoriasis is associated with a higher prevalence of metabolic syndrome compared to healthy controls, with significant impairments in quality of life and increased rates of anxiety and depression in psoriasis patients. The findings emphasize the importance of periodic evaluation for metabolic syndrome and psychological assessment in psoriasis patients to improve their overall well-being. The study also highlights the need for a holistic approach to managing psoriasis, considering both physical and psychological aspects of the disease.

Conflicts of Interest

The authors have carried out the work on their own and the ICMJE form for Disclosure of Potential Conflicts of Interest have been submitted and none were declared.

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