SPECIAL REPORT
555 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Health-related Quality of Life in Children and Adolescents with Psoriasis : A Systematic Review and Meta-analysis
Hilde RANDA 1 , 2 , Tanja TODBERG 3 , Lone SKOV 3 , Lotte S . LARSEN 4 and Robert ZACHARIAE 1 , 2
1
Unit of Psychooncology and Health Psychology , Department of Oncology , Aarhus University Hospital , 2 Department of Psychology and Behavioural Science , Aarhus University , Aarhus , 3 Department of Dermatology and Allergy , Gentofte Hospital , University of Copenhagen , Hellerup , and 4 LEO Pharma , Ballerup , Denmark
Studies demonstrating the negative impact of paediatric psoriasis on health-related quality of life ( HRQOL ) are accumulating , but little is known about moderators of HRQOL . The objectives of this review were to summarize studies on HRQOL in paediatric psoriasis and to explore the potential moderating influences of demographic and clinical variables . Searches were conducted by 2 independent researchers in PubMed , Embase , CINAHL , PsycINFO , and Scopus for papers published between 1995 ( the date the first dermatology-specific HRQOL-instrument for children was introduced ) and 2016 . Eligible studies were required to report HRQOL data for children and / or adolescents with psoriasis ( 4 – 18 years ) using validated HRQOL questionnaires . Seven teen eligible studies ( number of patients = 1,185 ) were identified . Moderation analyses revealed that study samples with a higher percentage of girls were associated with better HRQOL ( β = 0.19 ), while a higher mean age of onset ( β = 0.83 ) and study quality ( β = 0.28 ) were associated with lower HRQOL ( all p < 0.05 ). Several papers did not provide the information necessary for exploring between-study differences , thus the moderation analysis results should be interpreted with caution . In conclusion , children and adolescents with psoriasis experience moderate impairment of HRQOL . Certain demographic characteristics ( e . g . sex ) and clinical characteristics ( e . g . age at onset ) appear to moderate this impact .
Key words : psoriasis ; health-related quality of life ; children ; adolescents ; systematic review ; meta-analysis .
Accepted Dec 15 , 2016 ; Epub ahead of print Dec 16 , 2016 Acta Derm Venereol 2017 ; 97 : 555 – 563 .
Corr : Hilde Randa , Department of Psychology and Behavioural Science , Aarhus University , Bartholins Allè 9 , DK-8000 Aarhus C , Denmark . E- mail : hilderanda @ psy . au . dk
Psoriasis is a common chronic inflammatory skin disease with a prevalence of 2 – 3 % in Western countries ( 1 – 3 ). It is estimated that 0.7 – 1.2 % of all children suffer from psoriasis ( 3 , 4 ), with one-third of patients being diagnosed by the age of 20 years ( 2 ). Although psoriasis may take various clinical forms , the majority of children present with either plaque psoriasis ( 71 %) or guttate psoriasis ( 26 %) ( 5 ).
A European consensus report suggests that patients with psoriasis are both undertreated and underserved ( 6 ). Increased emphasis on patients ’ overall evaluation of disease impact was identified as a major step towards better treatment for patients . Reviews of studies on functioning in adult psoriasis have shown increased rates of comorbid mental disorders , especially anxiety and depression , in addition to a range of psychosocial problems , such as poor self-esteem , social stigmatization , physical limitations , sexual dysfunction , and suicidal ideations ( 7 , 8 ). Although paediatric patients have received far less research attention , a large study comparing paediatric patients with psoriasis ( n = 7,404 ) with psoriasis-free control subjects ( n = 37,020 ), also found a higher prevalence of depression and anxiety in paediatric patients ( 9 ). Identifying the optimal treatment for psoriasis can be a lengthy process , and the treatments can be burdensome , time-consuming , and associated with considerable side-effects ( 10 , 11 ). This may further challenge patients ’ well-being , especially in children who might lack a thorough understanding of the importance of treatment . Qualitative studies have also identified a number of psychosocial challenges in the daily lives of children with psoriasis ( 12 , 13 ).
In recent decades , studies have shed light on patients ’ subjective experiences of medical diseases and their impact on patient ’ s life , as captured by the construct of health-related quality of life ( HRQOL ) ( 14 ). Although operational definitions vary , HRQOL is generally conceptualized as a multidimensional construct reflecting patients ’ physical , psychological , and social well-being ( 15 – 17 ). HRQOL can be measured using generic or disease-specific questionnaires . Generic instruments have been constructed to apply to healthy individuals as well as people with medical issues , whereas diseasespecific instruments are tailored to specific populations with a given disease or symptom and thus tend to be more sensitive ( 15 ). Research on the association between psoriasis-related HRQOL and clinical measures of disease severity , e . g . the Psoriasis Area and Severity Index ( PASI ) ( 18 ), generally show modest correlations ( 19 ), indicating that the traditional measures of disease severity do not fully capture the impact of psoriasis on well-being . It is thus widely accepted that psoriasis treatment should aim not only at minimizing the extent and severity of psoriasis , but also at reducing the negative impact on patients ’ HRQOL ( 6 , 20 , 21 ).
In 2004 , de Korte et al . ( 22 ) published a systematic review of 17 studies on HRQOL in patients with
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2017 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2600 Acta Derm Venereol 2017 ; 97 : 555 – 563