Original Article

The Influence of Treatment Modalities on the Quality of Life of Psoriasis Patients


Background: We aimed to identify the quality of life (QoL) of patients with psoriasis, to determine the possible differences depending on the therapeutic modalities (biologic, conventional treatment and phototherapy), and to examine other variables that could affect the success of the treatment.

Methods: This research was a non-experimental, quantitative, observational study that included 183 psoriasis patients. The study was conducted from November 2021 to December 2022 at the University Clinical Center Kragujevac, Serbia. The following instruments were used: Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), as well as a general questionnaire that contained a set of questions which referred to sociodemographic data.

Results: There was a statistically significant difference in the average values of the DLQI score concerning the application of different therapeutic modalities (P<0.001). Biologic treatment was the modality with the lowest impairments in the QoL domain (average value of DLQI score 10.6±7.3), followed by patients on conventional treatment (average value of DLQI score 12.9±7.9), and the highest levels of impaired QoL were in patients who received phototherapy (average value of the DLQI score 13.7±9.3).

Conclusion: Patients on biological therapy at all four time points individually (baseline, 4, 12 and 16 weeks) had the lowest average values of the DLQI score, i.e. the best QoL compared to subjects who received other therapy.


1. Nguyen SH, Nguyen LH, Vu GT, et al (2019). Health-Related Quality of Life Impairment among Patients with Differ-ent Skin Diseases in Vietnam: A Cross-Sectional Study. Int J Environ Res Public Health, 16: 305.
2. Griffiths CEM, Armstrong AW, Gudjons-son JE, Barker JNWN (2021). Psoriasis. Lancet, 397: 1301-15.
3. Golbari NM, Porter ML, Kimball AB (2018). Current guidelines for psoriasis treatment: a work in progress. Cutis, 101: 10-2.
4. Flytström I, Stenberg B, Svensson A, Bergbrant IM (2008). Methotrexate vs. ciclosporin in psoriasis: effectiveness, quality of life and safety. A randomized controlled trial. Br J Dermatol, 158: 116-21.
5. Svedbom A, Ståhle M (2020). Real-world comparative effectiveness of adalimumab, etanercept and methotrexate: a Swedish register analysis. J Eur Acad Dermatol Vene-reol, 34: 525-32.
6. Zhang P, Wu MX (2018). A clinical review of phototherapy for psoriasis. Lasers Med Sci, 33: 173-80.
7. Gahalaut P, Mishra N, Soodan PS, Rastogi MK (2014). Effect of Oral PUVAsol on the Quality of Life in Indian Patients Having Chronic Plaque Psoriasis. Dermatol Res Pract, 2014: 291586.
8. Sbidian E, Chaimani A, Afach S, et al (2020). Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev, 1: CD011535.
9. Guo F, Yu Q, Liu Z, et al (2020). Evaluation of life quality, anxiety, and depression in patients with skin diseases. Medicine (Balti-more), 99: e22983.
10. Gu Y, Zhang H, Ali SH, et al (2019). Social Determinants of Health-Related Quality of Life among Residents in Zhejiang and Qinghai, China. Int J Environ Res Public Health, 16: 1314.
11. World Medical Association (2013). World Medical Association Declaration of Hel-sinki: Ethical Principles for Medical Re-search Involving Human Subjects. JA-MA, 310: 2191-4.
12. Finlay AY, Khan GK (1994). Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol, 19: 210-6.
13. Fredriksson T, Pettersson U (1978). Severe psoriasis-oral therapy with a new retinoid. Dermatologica, 157: 238-44.
14. Maravilla-Herrera P, Merino M, Alfonso Zamora S, et al (2023). The social value of a PASI 90 or PASI 100 response in pa-tients with moderate-to-severe plaque psoriasis in Spain. Front Public Health, 11: 1000776.
15. Ahmad Fuat MS, Mat Yudin Z, Muhammad J, Mohd Zin F (2022). Quality of Life and Its Associated Factors among Patients with Psoriasis in a Semi-Urban Northeast Malaysia. Int J Environ Res Public Health, 19: 11578.
16. Gorelick J, Shrom D, Sikand K, et al (2019). Understanding Treatment Preferences in Patients with Moderate to Severe Plaque Psoriasis in the USA: Results from a Cross-Sectional Patient Survey. Dermatol Ther (Heidelb), 9: 785-97.
17. Mahil SK, Ezejimofor MC, Exton LS, et al (2020). Comparing the efficacy and toler-ability of biologic therapies in psoriasis: an updated network meta-analysis. Br J Dermatol, 183: 638-49.
18. Imafuku S, Kanai Y, Murotani K, et al (2021). Utility of the Dermatology Life Quality Index at initiation or switching of biologics in real-life Japanese patients with plaque psoriasis: Results from the ProLOGUE study. J Dermatol Sci, 101: 185-93.
19. Norris D, Photiou L, Tacey M, et al (2017). Biologics and dermatology life quality in-dex (DLQI) in the Australasian psoriasis population. J Dermatolog Treat, 28: 731-6.
20. Barbieri JS, Gelfand JM (2019). Influence of "Not Relevant" Responses on the Der-matology Life Quality Index (DLQI) for Patients With Psoriasis in the United States. JAMA Dermatol, 155: 743-5.
21. Houghton K, Patil D, Gomez B, Feldman SR (2021). Correlation Between Change in Psoriasis Area and Severity Index and Dermatology Life Quality Index in Pa-tients with Psoriasis: Pooled Analysis from Four Phase 3 Clinical Trials of Secukinumab. Dermatol Ther (Heidelb), 11: 1373-84.
22. Boch K, Zillikens D, Ludwig RJ, Thaçi D (2022). Paradoxical improvement of life quality in the COVID-19 era in psoriasis patients. PLoS One, 17: e0275293.
23. Sendrasoa FA, Razanakoto NH, Ratovonja-nahary V, et al (2020). Quality of Life in Patients with Psoriasis Seen in the De-partment of Dermatology, Antananarivo, Madagascar. Biomed Res Int, 2020: 9292163.
24. Decean L, Badea M, Rus V, et al (2022). The Implication of Misinformation and Stig-ma in Age-Related Quality of Life, De-pression, and Coping Mechanisms of Adult Patients with Psoriasis. Medicina (Kaunas), 58: 1420.
25. López-Mejía R, Ramales-Montes EM, Ley-Silva LS, Romero-Sansalvador CY, Gutiérrez-Gabriel I (2022). Quality of life, depression and its relation to the severity in psoriasis. Rev Med Inst Mex Seguro Soc, 60: 315-20.
26. Kwan Z, Bong YB, Tan LL, et al (2018). Determinants of quality of life and psy-chological status in adults with psoriasis. Arch Dermatol Res, 310: 443-51.
27. García-Sánchez L, Montiel-Jarquín ÁJ, Vázquez-Cruz E, et al (2017). Quality of life in patients with psoriasis. Gac Med Mex, 153: 185-9.
28. Quinto RM, De Vincenzo F, Graceffa D, Bonifati C, Innamorati M, Iani L (2022). The Relationship between Alexithymia and Mental Health Is Fully Mediated by Anxiety and Depression in Patients with Psoriasis. Int J Environ Res Public Health, 19: 3649.
29. Park SY, Kim KH (2021). What Factors In-fluence on Dermatology-Related Life Quality of Psoriasis Patients in South Ko-rea?. Int J Environ Res Public Health, 18: 3624.
30. Prignano F, Brunasso AMG, Fabbrocini G, et al (2022). Sharing Patient and Clinician Experiences of Moderate-to-Severe Pso-riasis: A Nationwide Italian Survey and Expert Opinion to Explore Barriers Im-pacting upon Patient Wellbeing. J Clin Med, 11: 2801.
IssueVol 52 No 9 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v52i9.13574
Quality of life Psoriasis Biologics Phototherapy Conventional treatment

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How to Cite
Milidrag A, Safiye T, Gutić M, Zlatanović M, Stevanović A, Dubljanin J, Despotović M, Miličić V, Radević S, Ravić-Nikolić A. The Influence of Treatment Modalities on the Quality of Life of Psoriasis Patients. Iran J Public Health. 2023;52(9):1925-1934.