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