Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2011:77:3;333-334
doi: 10.4103/0378-6323.79716
PMID: 21508577

Quality of life in psoriasis patients in KwaZulu Natal, South Africa

Preetha Hariram1 , Anisa Mosam1 , Jamila Aboobaker1 , Tonya Esterhuizen2
1 Department of Dermatology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban,
2 Program of BioResearch Ethics and Medical Law, College of Health Sciences, University of KwaZulu-Natal, Durban,

Correspondence Address:
Preetha Hariram
Department of Dermatology, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Durban

How to cite this article:
Hariram P, Mosam A, Aboobaker J, Esterhuizen T. Quality of life in psoriasis patients in KwaZulu Natal, South Africa. Indian J Dermatol Venereol Leprol 2011;77:333-334
Copyright: (C)2011 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

The uses of quality of life (QOL) indices have been detailed in a previous review. [1] Developing countries lag behind in making QOL a target of holistic patient care. This is the first QOL study on psoriasis, with a correlation of clinical severity and sites of involvement, conducted in South Africa (SA). It reflects on a multiracial community of predominantly the Indian and Black population group, in Stanger, KwaZulu Natal (KZN).

This was a cross-sectional study conducted in the Dermatology Outpatient Clinic. Consenting patients underwent the following: Clinical confirmation of the type of psoriasis, Psoriasis Area and Severity Index (PASI) scoring, percentage body surface area (BSA) calculation by the rule of nines, site of involvement, nail changes, and assessment for psoriatic arthritis. A comprehensive demographic questionnaire was used. QOL was assessed by the Dermatology Life Quality Index (DLQI) and the Psoriasis Disability Index (PDI). These indices were also translated into Zulu for Black participants.

The demographic profile is illustrated in [Table - 1].

Table 1: Demographic Profile of the Study Sample

The mean PASI score of Black participants was 23.0 (S.D. 14.6), which was significantly higher than that of Indians (mean 11.4, S.D. 7.7; P < 0.001). Rural patients had a significantly higher mean for PASI, of 17.2 (S.D. 12.8), compared to urban patients with a mean of 11.9 (S.D.8.7, P = 0.045). A change in the political era since the end of apartheid, in 1994, has resulted in an increased number of primary health clinics; however, access to healthcare is still difficult for most Black rural residents. Time to seek healthcare is delayed due to financial constraints and may account for more severe disease at presentation. Furthermore, consulting with traditional healers and beliefs of bewitchment is not uncommon in our setting and contributes to late referrals, with more advanced disease presentations.

The mean PDI score was 12.2 (S.D. 7.1) and the mean DLQI was 11.1 (S.D. 5.5). At least 50.7% (n = 35) had a DLQI score between 11 and 20, which equated to a ′very large effect on the quality of life′. The greatest impairment in the PDI was in the daily activities (mean 42.4%, S.D. 22.6). There were no significant associations between the demographic variables and the QOL. Specifically, despite there being a preponderance of Indian participants (75%), there was no significant difference in QOL scores between the ethnic groups. This highlights the fact that patients′ perception of the disease transcends racial and cultural grounds. This is supported by Gelfand et al., in their study sample consisting of African Americans and Caucasians. [2]

However, the site of involvement affected the QOL. Patients with head / neck and genitalia / groin involvement had significantly higher PDI scores ( P = 0.010 and 0.028) than those without the involvement of these sites. PDI scores for hand / foot involvement were non-significantly higher than those without involvement of this site ( P = 0.057). Those with head / neck, genitalia / groin, and hand / foot involvement had significantly higher DLQI scores ( P = 0.002, P = 0.004, and P = 0.038) than those who were not affected at these sites.

The sensitive sites of head / neck, hand / foot, and genitalia / groin affect all aspects of the quality of life, including interpersonal relationships, occupation, sport, recreation, and sexuality and intimacy issues. As an example, visible lesions on the head / neck region add to the social isolation, hand involvement can deter a handshake and groin involvement can make a sexual partner suspect an infectious etiology. Although involvement of these sites, alone or in combination, may result in a low BSA or PASI score, QOL impairment may be significantly greater. A previous report has referred to these sites as emotionally charged body regions that have a significant impact on QOL. [3]

Correlations of PASI with DLQI and PDI were weak (r = 0.352 and r = 0.281, respectively), similar to a previous study. [4] In contrast, an Iranian study has shown a good correlation between these QOL indices and PASI. [5] Socioeconomic, religious, and cultural differences could account for this difference. However, both these studies have shown a good correlation between the PDI and DLQI, similar to ours (r = 0.789). [4],[5]

This South African study demonstrates that a clinician assessment alone is inadequate to assess the overall severity of psoriasis. Furthermore, certain sites are prone to greater QOL impairment. It is critical that QOL tools become an important measure of patient satisfaction and treatment monitoring in the developing world.

References
1.
Finlay AY. Quality of life indices. Indian J Dermatol Venereol Leprol 2004;70:143-8.
[Google Scholar]
2.
Gelfand JM, Stern RS, Nijsten T, Feldman SR, Thomas J, Kist J, et al. The prevalence of psoriasis in African Americans: Results from a population-based study. J Am Acad Dermatol 2005;52:23-6.
[Google Scholar]
3.
Wolkenstein P. Living with Psoriasis. J Eur Acad Dermatol Venereol 2006;20:28-32.
[Google Scholar]
4.
Sampogna F, Sera F, Abeni D. Measures of Clinical Severity, Quality of Life, and Psychological Distress in Patients with Psoriasis: A Cluster Analysis. J Invest Dermatol 2004;122:602-7.
[Google Scholar]
5.
Aghaei S, Moradi A, Ardekani GS. Impact of psoriasis on quality of life in Iran. Indian J Dermatol Venereol Leprol 2009;75:220.
[Google Scholar]

Fulltext Views
1,083

PDF downloads
1,164
Show Sections