Available online at www.sciencedirect.

com
www.jdds.org

ScienceDirect
Journal of Dermatology & Dermatologic Surgery xxx (2015) xxxxxx

Original article

Psoriasis: Correlation between severity index (PASI) and quality

of life index (DLQI) based on the type of treatment
Ali Al Raddadi a, Abdulhadi Jfri b,, Sahal Samarghandi a, Nesreen Matury a, Taha Habibullah a,
Majed Alfarshoti c, Ahmad Mahdi a
a
King Abdulaziz Medical City, Jeddah, Saudi Arabia
b
King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
c
National Guard Hospital, Al Hassa, Saudi Arabia

Received 3 April 2015; accepted 22 May 2015

Abstract

Background: Psoriasis vulgaris is a common chronic dermatological disease that has a negative impact on the psychological status and
the social interaction of the patient.
Objective: To correlate the quality of life and clinical severity of psoriasis vulgaris in patients using dierent types of treatment.
Materials and methods: This is a prospective observational cross-sectional study that took place over a 4 month period, from January
to April 2014, at the King Abdul Aziz Medical City, Jeddah, Saudi Arabia. All patients with psoriasis vulgaris attending the dermatology
clinics during this period were included.
Results: Of the total 41 Saudi patients, 25 were males and 16 were females. 21 were on combined (i.e. topical with either systemic or
NB-UVB) and 20 were on topical treatments only. PASI score was moderate in the majority for both groups, that is, patients on topical
(70%) and combined treatment (80%). DLQI score shows only a small eect on the patients quality of life for the majority (14/20) in the
topical group and (16/21) for those on combined therapy.
Conclusion: There is no signicant dierence in terms of the eect of the type of treatment between the two groups.
2015 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Psoriasis vulgaris; Dermatology life quality index (DLQI); Psoriasis area and severity index (PASI)

1. Introduction (Grob and Folchetti, 1999; Koo, 1996; da Silva et al.,

Psoriasis is a relatively common, chronic condition
aecting between 1% and 3% of the general population
Corresponding author at: King Saud bin Abdulaziz University for
Health Sciences, Internal Mail 6556, P.O. Box 9515, Jeddah 21423, Saudi
Arabia. Tel.: +966 2 2245848; fax: +966 920008668x26243.
E-mail address: Abdulhadijfri@gmail.com (A. Jfri).
Peer review under responsibility of King Saud University.
Production and hosting by Elsevier
2013). Classic psoriasis vulgaris usually appears in specic
areas including the elbows, knees and scalp. Although nei-
ther life threatening nor contagious, psoriasis causes mea-
surable harm to patients health-related quality of life
(HRQoL) through the psychological and social conse-
quences of having plaques on the skin (Ramsay and
OReagan, 1988).
Generally, a diagnosis of psoriasis is informed by exam-
ination of the skin. The classic symptoms of psoriasis vul-
garis are highly visible chronic erythematous plaques
covered by silvery white scales, forming on the elbows,
knees, scalp, umbilicus and lumbar area (Schon and

http://dx.doi.org/10.1016/j.jdds.2015.05.002
2352-2410/ 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002
2 A.A. Raddadi et al. / Journal of Dermatology & Dermatologic Surgery xxx (2015) xxxxxx
Boehncke, 2005). The Dermatology quality of life index
(DLQI) is a10-item survey evaluating the quality of life
in patients with a skin disease, covering six domains: symp-
toms and feelings, daily activities, leisure, work and school,
Personal Relationships and treatment (Finlay and Khan,
1994). DLQI has-been found highly sensitive to improve-
ments in psoriasis symptoms and shows a positive correla-
tion with the psoriasis area severity index (PASI) (Basra
et al., 2008; Revicki et al., 2008). There are relatively few
studies in the literature examining the correlation between
quality of life and symptom severity in patients with psori-
asis (da Silva et al., 2013).
One study discusses the relationship between quality of
life and skin clearance in moderate-to-severe psoriasis
patients treated with iniximab (Reich and Griths,
2008). In Saudi Arabia, a study was done to evaluate the
quality of life in patients with psoriasis vulgaris before
and after phototherapy. This study concluded that narrow
band ultraviolet B (NB-UVB) photo therapy can improve
the quality of life in patients with psoriasis vulgaris (Al
Robaee and Alzolibani, 2011). To the best of our knowl-
edge, no prior study in our area compares quality of life
and clinical severity in patients using topical treatment
alone for psoriasis vulgaris with quality of life and clinical
severity in patients on combined treatment (that is, topical
treatment combined with either phototherapy or systemic)
to nd out if there is any correlation.
2. Purpose of the study
To evaluate the quality of life and clinical severity of
psoriasis vulgaris in patients on topical and combined
treatment and compare the dierences between the two
groups based on the type of the treatment.
3. Methods and materials
A cross sectional survey was conducted between January
1st and April 30th, 2014 enrolling patients with psoriasis
vulgaris attending the Dermatology clinic at the King
Abdul Aziz medical city (KAMC). The (KAMC)
National Guard Hospital is a 540-bed referral healthcare
facility and teaching hospital. It is located in Jeddah and
serves all National Guard soldiers, employees and
dependents, as well as eligible patients in the western region
of Saudi Arabia. Data were collected from the patients by
dermatologists. A 10 item questionnaire using the veried
Table 1
PASI score based on the type of the treatment.
PASI score result Topical treatment
Males Females Total
Mild (110) 2 2 4 2
Moderate (1020) 6 8 14
Severe (>20) 1 1 2 1
Total 9 11 20
Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002
Arabic version of dermatology life quality index (DLQI)
was administered to the patients and an assessment of the
disease was carried out by using the psoriasis area severity
index (PASI). Patient data were documented on a special
form, including gender, age, BMI, smoking status and
detailed information about the type of treatment, dose, fre-
quency and duration of treatment. The study was approved
by King Abdullah International Medical Research Center
(KAIMRC), protocol number is RJ13/033/J.
The collecting data sheets of all patients visiting the der-
matology clinics during the study period were reviewed. No
inclusion or exclusion criteria were applied. A total of 41
papers were entered into the system. Data analysis was car-
ried out using SPSS v16.0 and descriptive statistics were
used to analyze the patients data.
4. Results
A total of 41 patients with psoriasis vulgaris visited the
Dermatology clinic from January 2014 to April 2014. Of
these, 4 were newly diagnosed and 37 were known cases
coming in for follow-up. Of the 41 patients, 25 were males
and 16 were females, and all the patients were Saudi
nationals. The majority of the patients had been diagnosed
with psoriasis more than 10 years ago (23; 56.1%). Most of
those (31.71%) were having severe PASI score. Of the 41
patients, 21 were on combined treatment (topical with
either systemic or NB-UVB) and 20 were on topical treat-
ment only. The majority (11 out of 21 patients; 52.4%) of
those on combined treatment were on oral Methotrexate
with folic acid and topical calcipotriol with betamethasone
dipropionate ointment. The majority (17 out of 20 patients;
85%) of those on topical treatment were only on topical
calcipotriol with betamethasone dipropionate ointment.
PASI score was moderate in the majority of patients in
both groups, topical (14/20; 70%) and combined treatment
(17/21; 81%) (Table 1). Of the 41 patients, 17 (41.5%) had
nail changes in form of pitting and 9 (22%) had an estab-
lished diagnosis of psoriatic arthritis. The majority, 23
(56.1%), were obese and most of them (24.39%) had mild
PASI score. 19.5% were smokers in the study and the
majority of them 4 out of 8 (50%) were having severed
PASI score (Table 2). DLQI score shows only a small eect
on the patients quality of life for the majority (14/20) of
patients in the topical group and a moderate eect on the
patients quality of life for those on combined (16/21;
76.2%) (Table 3).
Combined treatment Total Percentage (%)
Males Females Total
1 3 7 17.07
10 7 17 31 75.61
0 1 3 7.32
13 8 21 41 100.00
 A.A. Raddadi et al. / Journal of Dermatology & Dermatologic Surgery xxx (2015) xxxxxx 3

Table 2
PASI score with Chronicity, body mass index (BMI) and smoking status.
PASI score result Chronicity BMI Smokers
<5 years 510 years >10 years Normal (1824) Over-weight (2530) Obese (>30)
Mild (110) 2 1 4 5 4 10 3
Moderate (1020) 3 3 6 3 0 6 1
Severe (>20) 4 5 13 2 4 7 4
Total 9 9 23 10 8 23 8

Table 3
DLQI score based on the type of the treatment.
DLQI score Topical treatment Combined treatment Total Percentage (%)
Males Females Total Males Females Total
No eect at all on patients life 2 1 3 2 0 2 5 12.20
Small eect on patients life 7 7 14 9 7 16 30 73.17
Moderate eect on patients life 0 2 2 1 1 2 4 9.76
Very large eect on patients life 0 1 1 1 0 1 2 4.88
Total 9 11 20 13 8 21 41 100.00

5. Discussion Conict of interest

The present study has produced evidence that psoriasis
has a meaningful negative impact on a patients QOL.
These results are consistent with previous researches on
psoriasis vulgaris (Choi and Koo, 2003; Fortune et al.,
1997; Finlay and Coles, 1995; Feldman et al., 1997). The
impact of the disease on patients QOL was principally
through emotional and psychological disability resulting
from the appearance of the plaques (Wahl et al., 2000;
Gupta and Gupta, 1997).
We found that quality of life was aected more or less
equally by dierent grades of psoriasis. No correlation
was found between the quality of life and clinical severity
of psoriasis vulgaris in patients using dierent types of
treatment. It has always been thought by many dermatolo-
gists that patients on combined systemic therapy are
expected to have a better quality of life and less clinical
severity compared to those who are only on topical ther-
apy. However, in study sample we can conclude that there
is no statistical dierence between the dierent lines of the
treatment in terms of one being superior to the other in
giving the patient convenient quality of life and less clinical
severity.
6. Conclusions
We can conclude that treatment modality is not the
main factor in our study in determining the psoriatic
patients quality of life and clinical severity. However, we
can suggest that the absence of correlation in the present
study can be because of the Saudi Arabian traditional
dress, which covers most of the body for men and women,
limits social embarrassments from psoriasis and helps
patients cope with the appearance of the plaques on their
skin.
The author has no conicts of interest that are directly
relevant to the content of this study. No sources of funding
were used to assist in preparation of this manuscript.
References
Al Robaee, A.A., Alzolibani, A.A., 2011. Narrowband ultraviolet B
phototherapy improves the quality of life in patients with psoriasis.
Saudi Med. J. 32 (6), 603606.
Basra, M.K., Fenech, R., Gatt, R.M., Salek, M.S., Finlay, A.Y., 2008.
The Dermatology Life Quality Index 19942007: a comprehensive
review of validation data and clinical results. Br. J. Dermatol. 159,
9971035.
Choi, J., Koo, J.Y., 2003. Quality of life issues in psoriasis. J. Am. Acad.
Dermatol. 49, S57S61.
da Silva, Maria Flavia Pereira, Fortes, Maria Rita Parise, Miot,
LucianeDonidaBartoli, Marques, Silvio Alencar, 2013. Psoriasis:
correlation between severity index (PASI) and systemic treatment.
An. Bras. Dermatol. 88 (5), 760763, ISSN 1806-4841.
Feldman, S.R., Fleischer, A.B., Reboussin, D.M., et al., 1997. The
economic impact of psoriasis increases with psoriasis severity. J. Am.
Acad. Dermatol. 37, 564569.
Finlay, A.Y., Coles, E.C., 1995. The eect of severe psoriasis on the
quality of life of 369 patients. Br. J. Dermatol. 132, 236244.
Finlay, A.Y., Khan, G.K., 1994. Dermatology Life Quality Index (DLQI)
a simple practical measure for routine clinical use. Clin. Exp.
Dermatol. 19, 210216.
Fortune, D.G., Main, C.J., OSullivan, T.M., et al., 1997. Quality of life in
patients with psoriasis: the contribution of clinical variables and
psoriasis-specic stress. Br. J. Dermatol. 137, 755760.
Grob, J.J., Folchetti, G., 1999. Epidemiology of psoriasis. In: Van
deKerkhof, P. (Ed.), Textbook of Psoriasis. Blackwell Science,
London, pp. 5767.
Gupta, M.A., Gupta, A.K., 1997. Psoriasis and sex: a study of moderately
to severely aected patients. Int. J. Dermatol. 36, 259262.
Koo, J., 1996. Population-based epidemiologic study of psoriasis with
emphasis on quality of life assessment. Dermatol. Clin. 14, 485496.
Ramsay, B., OReagan, M., 1988. A survey of the social and psychological
eects of psoriasis. Br. J. Dermatol. 118, 195201.

Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002
4 A.A. Raddadi et al. / Journal of Dermatology & Dermatologic Surgery xxx (2015) xxxxxx

Reich, K., Griths, C.E., 2008. The relationship between quality of life
and skin clearance in moderate-to-severe psoriasis: lessons learnt from
clinical trials with iniximab. Arch. Dermatol. Res. 300, 537544.
Revicki, D.A., Willian, M.K., Menter, A., Saurat, J.H., Harnam, N.,
Kaul, M., 2008. Relationship between clinical response to therapy and
health-related quality of life outcomes in patients with moderate to
severe plaque psoriasis. Dermatology 216, 260270.
Schon, M.P., Boehncke, W.H., 2005. Psoriasis. N. Engl. J. Med. 352,
18991912.
Wahl, A., Loge, J.H., Wiklund, I., et al., 2000. The burden of psoriasis: a
study concerning health-related quality of life among Norwegian
adults with psoriasis compared with general population norms. J. Am.
Acad. Dermatol. 43, 803808.

Please cite this article in press as: Raddadi, A.A. et al., Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the
type of treatment, Journal of Dermatology & Dermatologic Surgery (2015), http://dx.doi.org/10.1016/j.jdds.2015.05.002