[show abstract][hide abstract] ABSTRACT: Feelings of stigmatization are an important somatopsychic consequence of psoriasis, affecting the quality of life. It is thus relevant to supplement reliable statements about the detailed changes of stigmatization experience and psoriasis over time. In this study we compared the Psoriasis Area and Severity Index (PASI), the 'self-administered PASI' (SPASI) and the 'Questionnaire on Experience with Skin Complaints' of 166 psoriasis patients (64 women, 102 men) in a 1-year follow-up to assess the relation between these factors over time. The results suggest a more pronounced feeling of discrimination in women with no significant somatic differences between gender at the first measurement. In a prospective evaluation we found a clear proportion of 'discordant' courses of these parameters, mainly in women, indicating a contradictory relation of somatic improvement or deterioration vs subjective experience with skin complaints. All in all, these results show a moderate but significant relevance of skin state for feeling of stigmatization over time only in men, thus suggesting a considerable influence of other psychic variables, probably coping skills, especially in women.
[show abstract][hide abstract] ABSTRACT: Objective: The aim of this longitudinal study is to compare different dimensions of coping in psoriasis patients dependent on the development of the severity of this chronic skin disease. For this purpose we examined the patients� coping and their skin state in a 1-year follow-up. Methods: We assessed the severity of psoriasis with the Psoriasis Area and Severity Index (PASI) and the Self-Administered PASI (SPASI), and coping with the �Trier Coping with Illness Scales� in 262 inpatients. The severity of psoriasis estimated with the (S)PASI was defined as �mild� ([S]PASI 0.0 - 5.0), �moderate� ([S]PASI > 5.0 - 12.0), or �severe� ([S]PASI > 12.0). We divided the sample into five patient groups based on the somatic course of the (S)PASI in the 1-year follow-up: �improved�, �equally mild�, �equally moderate�, �equally severe�, and �worse�. Results: Psoriasis patients of the �improved� and �equally mild� groups showed a significant increase on the scale �Search for Social Integration� (p = 0.041 and p = 0.005) and a significant decrease in the dimensions �Threat Minimization� (p = 0.040 and p = 0.022) and �Search for Information and Exchange of Experiences� (p = 0.003 each) in the follow-up. However, significantly higher values in the dimensions �Rumination� (p = 0.029) and �Search for Support in Religion� (p = 0.001) in the follow- up were revealed for the patients of the �worse� group. Conclusion: The analysis firstly shows a clear empirically-based challenge in which areas patients with �equally severe� or �worse� psoriasis should be supported, i.e. the fields �Search for Social Integration�, �Threat Minimization�, and �Search for Information and Exchange of Experiences�. In addition, results suggest that special psychological or psychotherapeutic efforts are necessary to help this group to develop an alternative behavior to the depression-associated �rumination�.
Dermatology and Psychosomatics / Dermatologie und Psychosomatik 01/2004; 5(4):178-183.