건선 환자의 삶의 질

초록

Health related quality of life (HRQoL) is considered as important concept for individualized therapy. Psoriasis is a common, chronic immune-mediated skin disorder which showed negative impact on HRQoL. Therefore, it is inevitable to managing HRQoL in patients with psoriasis. HRQoL is regarded to consist of 5 domains (physical well-being, psychological well-being, social well-being, treatment, vitality) and there are lots of tools measuring these. Since Dermatology Life Quality Index (DLQI) cover 4 domains, it is reasonable to be widely used in various skin diseases. Even there are still some controversies in determinant of HRQoL in psoriasis patients, the younger woman working in contact with the public and high level of education showed poorer HRQoL. Also subjective symptoms such as itching and pain can deteriorate HRQoL. Furthermore, involvement of difficult-to-treat areas such as scalp, face, nail, genital, palm and sole area negatively affect to HRQoL. Since these areas have small impact on psoriasis area and severity index (PASI) because of small body surface area (BSA), improved PASI without regarding these factors can lead to undertreatment and make patient life uncomfortable. It is necessary to discuss further on how to interpret discrepancy in HRQoL according to the epidemiologic factors and involvement of difficult-to-treat areas. Not only evaluation tools of HRQoL are important, it would be also important to use evaluated HRQoL in modifying treatment strategy to improve treatment satisfaction. In Korea, severity and treatment strategy of psoriasis are determined based on PASI and BSA. However, from the fact that the correlation coefficient between PASI and DLQI reported range from 0.37 to 0.5, PASI and BSA are not the only factor determining HRQoL. Both American Academy of DermatologyNational Psoriasis Foundation guideline and recent expert consensus report in Korea mentioned in common that DLQI is recommended as an important mea surement evaluating of psoriasis severity with utility in clinical trials but is not used in real-world clinical practice frequently. However, European guideline reported in 2011 included DLQI in determining severity, treatment modality, and treatment response with PASI. Therefore, physicians need to thrive to change definition of moderate-to-severe psoriasis as including DLQI. Herein, we review the measurement tool and determinants of HRQoL in psoriasis patients and discuss the role of HRQoL in determining severity and treatment strategies.

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