How Do Different Psoriasis Management Strategies Impact Quality Of Life In Adult Patients With Chronic Plaque Psoriasis ? : A Systematic Review
Keywords:
Psoriasis, Quality of Life, DLQI, Biologic Therapies, Systemic Therapies, Topical Therapies, Combination Therapies, Chronic Plaque PsoriasisAbstract
Introduction: Psoriasis, a chronic immune-mediated inflammatory skin disorder, significantly impairs patients' quality of life (QoL) due to erythematous, scaly plaques, pruritus, pain, and psychological distress. The Dermatology Life Quality Index (DLQI) is widely used to assess QoL in psoriasis patients, with higher scores indicating greater impairment. Despite treatment advancements, many patients experience impaired QoL, necessitating effective management strategies. This study systematically evaluates the impact of various psoriasis management strategies on QoL in adult patients with chronic plaque psoriasis, aiming to identify treatments that yield the greatest improvements in symptom relief, daily functioning, and psychosocial well-being. Methods: This systematic review strictly adhered to the PRISMA 2020 guidelines. Studies were screened based on predefined eligibility criteria including adult participants with chronic plaque psoriasis, evaluation of psoriasis management strategies (topical, systemic, biologic, or phototherapy), QoL measurement using validated instruments (e.g., DLQI, SF-36, PSORIQoL), randomized controlled trials or prospective cohort designs, treatment duration of at least 12 weeks, and a sample size of 30 or more participants. Data extraction involved identifying study design, participant characteristics, intervention details, QoL outcome measures, and statistical analyses. A comprehensive search using Boolean MeSH keywords was conducted across multiple databases. Results: Forty studies were included in the systematic review. The majority of studies utilized randomized controlled trial designs (16 studies), with others being observational (8 studies) or pooled analyses/other designs (16 studies). Biologic therapies were examined in 28 studies, small molecule therapies in 5, topical therapies in 3, methotrexate in 2, and phototherapy and spa therapy in 1 each. The DLQI was the most frequently used QoL measurement tool, appearing in 38 studies. Biologic therapies consistently demonstrated the most robust improvements in QoL, with many studies reporting significant DLQI reductions and a high proportion of patients achieving minimal or no impact on QoL (DLQI 0/1). Conventional systemic therapies and combination approaches also showed QoL improvements, including significant symptom relief, particularly pruritus. Improvements were observed across QoL domains such as daily activities, symptom impact, and psychosocial well-being. Discussion: The findings highlight that biologic therapies offer substantial and clinically meaningful improvements in QoL for adult patients with chronic plaque psoriasis, often outperforming conventional systemic treatments. These benefits extend to crucial QoL domains, addressing not only physical symptoms but also psychosocial distress and daily functioning. The consistent reporting of DLQI 0/1 achievement with biologics underscores their efficacy in achieving minimal disease impact on patients' lives. While other treatments also contribute to QoL improvement, biologics appear to offer more comprehensive and sustained benefits. Conclusion: Biologic therapies are highly effective in improving the quality of life for adult patients with chronic plaque psoriasis, demonstrating superior outcomes in symptom relief, daily functioning, and psychosocial well-being compared to conventional systemic treatments. Further research is needed to explore long-term QoL outcomes and patient preferences across different management strategies.References
A. Armstrong, Delfina Guadalupe Villanueva Quintero, C. Echeverría, Yihua Gu, M. Karunaratne, and O. Reyes Servín. “Body Region Involvement and Quality of Life in Psoriasis: Analysis of a Randomized Controlled Trial of Adalimumab.” American Journal of Clinical Dermatology, 2016.
A. Armstrong, K. Reich, P. Foley, Chenglong Han, Michael Song, Yaung-Kaung Shen, Y. You, and K. Papp. “Improvement in Patient-Reported Outcomes (Dermatology Life Quality Index and the Psoriasis Symptoms and Signs Diary) with Guselkumab in Moderate-to-Severe Plaque Psoriasis: Results from the Phase III VOYAGE 1 and VOYAGE 2 Studies.” American Journal of Clinical Dermatology, 2018.
A. Armstrong, S. Desai, M. Gooderham, D. Rubenstein, P. Brown, A. Tallman, and L. Kircik. “34615 Tap- inarof Cream 1% Once Daily for Plaque Psoriasis: Dermatology Life Quality Index and Local Tolerability Scores from a Long-Term Extension Trial.” Journal of American Academy of Dermatology, 2022.
B. Strober, A. Gottlieb, B. Sherif, P. Mollon, I. Gilloteau, L. McLeod, T. Fox, et al. “Secukinumab Sus- tains Early Patient‐reported Outcome Benefits Through 1 Year: Results from 2 Phase III Random- ized Placebo‐controlled Clinical Trials Comparing Secukinumab with Etanercept.” Journal of American Academy of Dermatology, 2017.
C. Griffiths, L. Stein Gold, F. Cambazard, R. Kalb, D. Lowson, A. Møller, and C. Paul. “Greater Improve- ment in Quality of Life Outcomes in Patients Using Fixed-Combination Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam Versus Gel: Results from the PSO-ABLE Study.” EJD. European Journal of Dermatology, 2018.
D. H. Kim, S. Son, K. Jeong, Jiyoung Ahn, Eun-So Lee, Il-Hwan Kim, U. Lee, et al. “Real-World Outcomes of Adalimumab Treatment for Moderate and Severe Psoriasis in Korean Patients (RAPSODI Study).” Annals of Dermatology, 2023.
D. Rigopoulos, A. Patsatsi, C. Antoniou, D. Sotiriadis, A. Roussaki-Schulze, N. Boubouchairopoulou, I. Skiadas, Vasillios Tsekouras, and A. C. Hernandez Daly. “Real-World Treatment Patterns, Patient- Reported Outcomes, and Effectiveness of Flexibledosing Etanercept in Patients with Plaque Psoriasis in Greece.” Dermatology Reports, 2022.
D. Thaçi, B. Strober, K. Gordon, P. Foley, M. Gooderham, A. Morita, K. Papp, et al. “Deucravacitinib in Moderate to Severe Psoriasis: Clinical and Quality-of-Life Outcomes in a Phase 2 Trial.” Dermatologic Therapy, 2022.
D. Thaçi, K. Papp, K. Reich, R. Langley, A. Mehta, Q. Li, and C. La Rosa. “FRI0446 Treatment with Tildrakizumab, An Anti-IL-23P19 Monoclonal Antibody, Improves Health-Related Quality of Life in Patients with Chronic Plaque Psoriasis,” 2016.
E. Edson-Heredia, Subhashis Banerjee, Baojin Zhu, Tomoko Maeda-Chubachi, Gregory S. Cameron, Wei Shen, Michael P. Heffernan, Kenneth B. Gordon, and Craig L. Leonardi. “A High Level of Clinical Response Is Associated with Improved Patient‐reported Outcomes in Psoriasis: Analyses from a Phase 2 Study in Patients Treated with Ixekizumab.” Journal of the European Academy of Dermatology and Venereology, 2016.
E. Lau, Joanne Bowers, Aoife Daly, R. Gonçalves, M. Charalambides, Naayema Hussain, J. Coumbe, A. Layton, and C. Flohr. “P87: Isotretinoin Dosing: Is It Spot on?” British Journal of Dermatology, 2022.
F. Bardazzi, L. Bigi, A. Campanati, A. Conti, V. Di Lernia, S. di Nuzzo, S. Kaleci, et al. “Outcome Following a Short Period of Adalimumab Dose Escalation as Rescue Therapy in Psoriatic Patients.” EJD. European Journal of Dermatology, 2020.
G. Pellacani, L. Bigi, A. Parodi, M. Burlando, C. Lanna, E. Campione, F. Rongioletti, et al. “Efficacy and Safety of Dimethyl Fumarate in Patients with Moderate-to-Severe Plaque Psoriasis: DIMESKIN-2, a Multicentre Single-Arm Phase IIIb Study.” Journal of Clinical Medicine, 2022.
J. Bagel, L. Gold, J. D. Del Rosso, S. Johnson, P. Yamauchi, P. Brown, N. Bhatia, A. Moore, and A. Tallman. “Tapinarof Cream 1% Once Daily for the Treatment of Plaque Psoriasis: Patient-Reported Outcomes from the PSOARING 3 Trial.” Journal of American Academy of Dermatology, 2023.
J. Heim, J. G. Vásquez, P. Beute, Monique Torres, S. Rozzo, and N. Bhatia. “33133 A Phase 4, Real- World Study of Tildrakizumab in Moderate to Severe Psoriasis: Week 28 Interim Analysis.” Journal of American Academy of Dermatology, 2022.
J. Hughes, L. Savage, E. Riley, V. Derodra, A. Bewley, O. Kwon, Abraham, et al. “P79: Efficacy of Baricitinib in Adults with Alopecia Areata: Patients’ Perspectives on Hair Regrowth from Two Phase III Randomized Controlled Trials (BRAVE‐AA1 and BRAVE‐AA2).” British Journal of Dermatology, 2022.
J. Lambert, J. B. Hansen, A. Sohrt, and L. Puig. “Dermatology Life Quality Index in Patients with Moderate- to-Severe Plaque Psoriasis Treated with Brodalumab or Ustekinumab.” Dermatologic Therapy, 2021.
J. Leman, S. Walton, A. Layton, K. A. Ward, S. McBride, S. Cliff, A. Downs, M. Landeira, and A. Bewley. “The Real World Impact of Adalimumab on Quality of Life and the Physical and Psychological Effects of Moderate-to-Severe Psoriasis: A UK Prospective, Multicenter, Observational Study.” Journal of Dermatological Treatment (Print), 2020.
K. Gordon, M. Sebastian, and S. Feldman. “31085 Bimekizumab Early Treatment Response Translates into Cumulative Benefits in Health-Related Quality of Life in Patients with Moderate to Severe Plaque Psoriasis: Pooled Results from Three Multicenter, Randomized, Double-Blinded Phase 3 Trials.” Journal of American Academy of Dermatology, 2022.
K. Houghton, Dhaval K. Patil, B. Gomez, and S. Feldman. “Correlation Between Change in Psoriasis Area and Severity Index and Dermatology Life Quality Index in Patients with Psoriasis: Pooled Analysis from Four Phase 3 Clinical Trials of Secukinumab.” Dermatologic Therapy, 2021.
L. Gold, K. Papp, D. Pariser, L. Green, N. Bhatia, H. Sofen, L. Albrecht, et al. “EFFICACY AND SAFETY OF APREMILAST IN PATIENTS WITH MILD TO MODERATE PLAQUE PSORIASIS: RESULTS OF A PHASE 3, MULTICENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL.” Journal of American Academy of Dermatology, 2021.
L. Gold, K. Papp, D. Pariser, N. Bhatia, H. Sofen, L. Albrecht, M. Gooderham, et al. “Efficacy and Safety of Apremilast in Patients With Mild to Moderate Psoriasis Up to 32 Weeks: Results From the Extension Phase of the Randomized, Phase 3 ADVANCE Trial.” Journal of American Academy of Dermatology, 2022.
L. Spelman, D. Rubel, A. Brnabic, N. Burkhardt, E. Riedl, and P. Foley. “A Subset Analysis of Efficacy and Safety Outcomes from Phase 3 Clinical Studies of Ixekizumab for the Treatment of Patients with Severe Plaque Psoriasis.” Journal of Dermatological Treatment (Print), 2020.
M. Abrouk, Mio Nakamura, T. Zhu, B. Farahnik, J. Koo, and T. Bhutani. “The Impact of PASI 75 and PASI 90 on Quality of Life in Moderate to Severe Psoriasis Patients.” Journal of Dermatological Treatment (Print), 2017.
M. Augustin, J. Lambert, C. Zema, E. Thompson, Min Yang, E. Wu, V. Garcia-Horton, et al. “Effect of Risankizumab on Patient-Reported Outcomes in Moderate to Severe Psoriasis.” JAMA Dermatology, 2020.
M. Beylot‐Barry, E. Mahé, C. Rolland, M. A. de la Bretèque, Claire Eychenne, J. Charles, C. Payen, et al. “Evaluation of the Benefit of Thermal Spa Therapy in Plaque Psoriasis: The PSOTHERMES Randomized Clinical Trial.” International Journal of Biometeorology, 2022.
M. Lebwohl, A. Blauvelt, A. Menter, K. Papp, S. Guenthner, R. Pillai, R. Israel, and A. Jacobson. “Efficacy, Safety, and Patient-Reported Outcomes in Patients with Moderate-to-Severe Plaque Psoriasis Treated with Brodalumab for 5 Years in a Long-Term, Open-Label, Phase II Study.” American Journal of Clinical Dermatology, 2019.
M. Lebwohl, A. Soliman, Hongbo Yang, Jessie Wang, K. Hagan, B. Padilla, and A. Pinter. “Impact of Risankizumab on PASI90 and DLQI0/1 Duration in Moderate-to-Severe Psoriasis: A Post Hoc Analysis of Four Phase 3 Clinical Trials.” Dermatologic Therapy, 2021.
M. Noe, M. Wan, D. Shin, A. Armstrong, K. Duffin, Z. C. Chiesa Fuxench, R. Kalb, et al. “Patient-Reported Outcomes of Adalimumab, Phototherapy, and Placebo in the Vascular Inflammation in Psoriasis Trial: A Randomized Controlled Study.” Journal of American Academy of Dermatology, 2019.
N. Korman, H. Sofen, S. Fretzin, P. Rich, Yang Zhao, V. Herrera, J. Nyirady, N. Williams, M. Mordin, and S. Tyring. “Secukinumab Provides Better Relief from the Impact of Psoriasis on Daily Activities and Personal Relationships Than Etanercept: Results of Two Phase 3 Placebo-Controlled Randomized Clinical Trials in Moderate-to-Severe Psoriasis.” Journal of Dermatological Treatment (Print), 2017.
P. Hampton, P. Brunner, K. Ghoreschi, W. Boehncke, Rhys Warham, V. Ciaravino, Balint Szilagyi, F. Staelens, and A. Foulkes. “P94 Bimekizumab Early Treatment Response Translated into Cumulative Benefits in Health-Related Quality of Life in Patients with Moderate-to-Severe Plaque Psoriasis: Results from 2 Years of the BE RADIANT Phase IIIb Trial.” British Journal of Dermatology, 2023.
R. Warren, B. Strober, M. Lebwohl, P. Foley, R. Langley, Leah Davis, B. Hoepken, Balint Szilagyi, V. Ciaravino, and A. Bewley. “PS14 Bimekizumab Response up to 3 Years in Patients with Moderate-to- Severe Plaque Psoriasis Who Responded at Week 16: Post Hoc Results from the BE BRIGHT Open-Label Extension Trial.” British Journal of Dermatology, 2023.
S. Atalay, J. M. Van den Reek, A. D. den Broeder, L. V. van Vugt, M. Otero, M. D. Njoo, J. M. Mommers, et al. “Comparison of Tightly Controlled Dose Reduction of Biologics With Usual Care for Patients With Psoriasis: A Randomized Clinical Trial.” JAMA Dermatology, 2020.
S. Feldman, B. Gomez, Xiangyi Meng, and R. Germino. “Secukinumab Rapidly Improves EQ-5D Health Status in Patients with Psoriasis: Pooled Analysis from Four Phase 3 Trials.” Journal of Dermatological Treatment (Print), 2019.
S. Feldman, D. Thaçi, M. Gooderham, M. Augustin, C. de la Cruz, L. Mallbris, M. Buonanno, et al. “Tofacitinib Improves Pruritus and Health-Related Quality of Life up to 52 Weeks: Results from 2 Randomized Phase III Trials in Patients with Moderate to Severe Plaque Psoriasis.” Journal of American Academy of Dermatology, 2016.
S. Feldman, N. Reznichenko, G. Pulka, K. Kingo, George Galdava, F. Berti, J. Sobierska, et al. “Efficacy, Safety and Immunogenicity of AVT02 Versus Originator Adalimumab in Subjects with Moderate to Severe Chronic Plaque Psoriasis: A Multicentre, Double-Blind, Randomised, Parallel Group, Active Control, Phase III Study.” BioDrugs, 2021.
S. Neema, B. Vasudevan, Pratibha Misra, Roma Rai, M. Sibin, Senkadhir Vendhan, S. Banerjee, Vinay Gera, and A. K. Yadav. “Treating Adult Patients of Severe Psoriasis with Methotrexate Leads to Reduction in Biomarkers of Atherosclerosis: A Prospective Study.” Medical Journal Armed Forces India, 2023.
V. Lajevardi, Z. Hallaji, Soroush Daklan, R. Abedini, A. Goodarzi, and Mona Abdolreza. “The Efficacy of Methotrexate Plus Pioglitazone Vs. Methotrexate Alone in the Management of Patients with Plaque‐type Psoriasis: A Single‐blinded Randomized Controlled Trial.” International Journal of Dermatology, 2015.
VV Karamata, A. Gandhi, P. Patel, A. Sutaria, and Mira Desai. “A Study of the Use of Drugs in Patients Suffering from Psoriasis and Their Impact on Quality of Life.” Indian Journal of Pharmacology, 2017.
W. Tillett, A. Egeberg, E. Sonkoly, P. Gorecki, A. Tjärnlund, J. Buyze, S. Wegner, and D. McGonagle. “POS1033 DYNAMICS OF NAIL PSORIASIS WITH GUSELKUMAB TREATMENT AND WITH- DRAWAL IN ASSOCIATION WITH SKIN RESPONSE AND PATIENT-REPORTED OUTCOMES: A POST HOC ANALYSIS OF THE VOYAGE 2 PHASE 3 TRIAL.” Annals of the Rheumatic Diseases, 2022.
Published
Issue
Section
License
Copyright (c) 2025 Eva Susilawetty Samosir, Eko John Wesley Butar Butar, Malinda R Siburian (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
