br Patients and methods All patients agreed to
Patients and methods All patients agreed to participate in the project and signed an informed consent after the investigators explained the purposes of this study. A total of 200 patients received oral questionnaires which were carried out in Chinese by an interviewer. The interviewer was a dermatologist with a good knowledge of both English and Chinese. The QoL of all included patients was assessed on the basis of these data. The collected data included general personal data as well as detailed records of family history, work patterns, site of involvement, and complications. The severity of psoriasis was quantitatively assessed by physicians using the Psoriasis Area and Severity Index (PASI). With regard to QoL assessment, Skindex-16, which is a reliable QoL scale for skin disease patients, was used. Patients have to respond to 16 subscales initially; these are further subdivided into three dimensions of symptoms, emotions, and life and social functions. In this study, we added occupational function as a fourth dimension; therefore, the questionnaire eventually comprised 21 questions (Table S1). Each question relating to QoL required patients to rate the degree of irritation felt during the past month on a scale of (never bothered) to 100 (always bothered). The higher the score, the more the quality of life is impaired. The scale score is the mean of the patients\' responses to the items in the given scale. During evaluation of the QoL of patients, the characteristics of each set of data were considered and various statistical methods were used. For the comparison of continuous variables between samples according to a nonparametric corticotropin-releasing factor and in situations with nonnormal distribution or a small sample size, the Mann-Whitney U test was used for two independent samples and the Jonckheere-Terpstra test was used to test for ordered differences among classes.
Results The patients with psoriasis reported severe interference in all aspects of their lives compared with the patients with general skin diseases. The degree of deterioration in the QoL of patients was statistically significant in terms of all the four dimensions (p < 0.001; Table 1), namely symptoms (psoriasis: control group 37.0:21.9), emotions (62.6:40.2), life and social functions (42.1:16.6), and occupational function (24.3:5.0). The PASI scores of patients were analyzed to understand the correlation between QoL deterioration and clinical symptom severity; no correlation was observed (Table 1). With regard to the duration of disease, QoL deterioration was unrelated to symptoms, emotions, life and social functions, or occupational function. There were no age-related differences in the degree of influence on QoL (Table 2). With regard to sex, the degree of influence of symptoms was slightly higher in women than in men (43.3 vs. 34.6); the same trend was observed for the emotions dimension (63.7 vs. 62.2). The opposite was true for the dimensions of life and social functions (women 41.1 vs. men 42.4) and occupational function (women 18.7 vs. men 26.4). However, none of the differences were statistically significant, indicating that sex is not a significant factor affecting the QoL of patients with psoriasis (Table 3). To evaluate the influence of education on the QoL, the patients were divided into a group that had received an education of high school level or below and a group that had received education at college level or higher. This was done to analyze whether education influences patient acceptance of the disease, QoL improvement, and the ability to receive and search information relating to the disease. The result showed no influence of education on QoL deterioration (Table 4). Similarly, family history of psoriasis had no influence on QoL deterioration (Table 5). However, patients with disease involving their hands were more depressed (59.1:26.9) and more severely affected in terms of life and social functions (45.3:13.4) and occupational function (27.2:4.0) compared with those with general skin diseases involving their hands (Table 6). Furthermore, although there was no significant difference between patients with general skin diseases and those with psoriasis in terms of symptom severity (38.9:30.6), patients with psoriasis involving their hands worried more about losing their job (29.0) compared with patients with other skin diseases involving their hands (8.5). For psoriasis patients alone, patients with hand involvement were also more depressed (22.8:59.1) and more affected in terms of life and social functions (27.2:45.3) and occupational function (11.0:27.2) compared with those without hand involvement (Table 7).