A cognitive‐behavioural symptom management programme as an adjunct in psoriasis therapy
ABSTRACT Background Patients with psoriasis may experience significant psychological and social disabilities. Stress or distress are proposed aggravators of the disease process in psoriasis. Preliminary studies to date have suggested that adjunctive psychological therapies may be effective in the clinical management of psoriasis.Objectives To examine whether a 6-week multidisciplinary management approach, the Psoriasis Symptom Management Programme (PSMP) for patients with psoriasis improves clinical severity of psoriasis and its associated psychological distress and disability.Methods In a case–control study, patients with psoriasis attending an out-patient psoriasis speciality clinic chose to receive standard psoriasis treatment alone (n = 53) or to enter the PSMP as an adjunct to standard therapy (n = 40). They were assessed at baseline, at the end of the 6-week PSMP and after 6 months follow-up.Results As compared with standard treatment alone, analysis of covariance indicated that participation in the PSMP resulted in a greater reduction in clinical severity of psoriasis (P = 0·001), anxiety (P = 0·001), depression (P = 0·001), psoriasis-related stress (P = 0·001) and disability (P = 0·04) at 6 weeks and 6 months follow-up.Conclusions The management of the physical aspects of psoriasis and its psychological effects are significantly improved for patients who opt for a 6-week integrated multidisciplinary approach. Furthermore, the techniques learnt by participation in the PSMP facilitate continued control of psoriasis for at least 6 months.
- Journal der Deutschen Dermatologischen Gesellschaft 12/2006; 4 Suppl 2:S1-126. · 1.40 Impact Factor
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ABSTRACT: Narrow-band ultraviolet (UV) B phototherapy is an effective treatment for psoriasis. However, there is considerable variability in the number of treatment sessions needed to achieve psoriasis clearance. While several clinical and treatment-related factors predict time to clearance, the effect of itching and scratching on the number of irradiation sessions is insufficiently understood. Predictors of the time to clearance were assessed in patients with psoriasis who were referred for UVB treatment in a randomized double-blind comparison of irradiation regimens for UVB phototherapy. After randomization to either UVB irradiation with a suberythematogenic or an erythematogenic regimen, patients were irradiated with 20% and 40% incremental doses, respectively, three times weekly. The Psoriasis Area and Severity Index (PASI) score was measured at baseline and every 4 weeks, and itching and habitual scratching were measured at baseline. Among the 77 patients who achieved psoriasis clearance (90% reduction of PASI), itching and scratching were correlated with the number of irradiation sessions needed to achieve clearance, with higher levels of itch and scratching predicting more sessions. These effects remained significant after controlling for the initial PASI score, irradiation schemes, minimal erythema dose (MED), skin type, cumulative dose, protocol adjustments and lifestyle factors (smoking habits and alcohol consumption). Patients with higher levels of itch and scratching need more irradiation sessions to achieve clearance of psoriasis with UVB phototherapy. Systematic assessment of the severity of itch and scratching, followed by short-term itch-coping programmes for patients at risk, might be a cost-effective, adjunct to UVB therapy.British Journal of Dermatology 05/2009; 161(3):542-6. · 3.76 Impact Factor
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ABSTRACT: Chronic inflammatory skin disorders have a major impact on the patients' health related quality of life. Preliminary studies to date have suggested that additional educational and psychological training programmes may be effective in the management of chronic skin diseases, although more rigid methodology is needed. Our purpose was to investigate the effect on quality of life of a novel multidisciplinary educational programme for patients, 18 years or older, with chronic skin diseases. The 12-week intervention encompasses cognitive education on skin and general health issues, and stress-reducing techniques. Quality of life questionnaires were used to assess the participants at baseline and at the end of the program. These comprehend Dermatology Life Quality Index (DLQI), Skindex-29, Psoriasis Disability Index (PDI) and Quality of Life Index for Atopic Dermatitis (QoLIAD). Fifty-five patients participated in six programmes since 2006. Forty-three patients completed the programme. Overall, compared to baseline, DLQI (n = 39) improved by 5.64 points (p < 0.001; SD ±6.09), Skindex-29 (n = 27) by 19.67 points (p < 0.001; SD ±17.37), PDI (n = 9) improved by 7.44 points (p = 0.019; SD ±7.60) and QoLIAD (n = 13) improved by 4.39 points (p = 0.036; SD ±6.69) by the end of the intervention. Preliminary results show that the quality of life of the patients with chronic skin diseases improved significantly after participation to the programme. These positive initial results are stimulating to set up a prospective controlled randomised trial investigating the impact on quality of life, the clinical efficacy and the cost-effectiveness of this educational intervention programme.Archives for Dermatological Research 01/2011; 303(1):57-63. · 2.71 Impact Factor