Psoriasis is a chronic immune-mediated inflammatory disease with skin and systemic manifestations that can result in a serious impairment of the patient's quality of life [1-4]. The main interest of the pathology is the cutaneous one that can present with different types of phenotypes even in the same individual, while, at a systemic level, the release of proinflammatory cytokines by immune cells and the chronic activation of the innate and acquired immune system determine damage at the level of different organs over time [5-7]. Psoriasis is associated with rheumatic problems and, in particular, psoriatic arthritis, autoimmune disorders, increased cardiovascular risk, metabolic disorders (obesity and metabolic syndrome), respiratory disorders (chronic obstructive pulmonary disease, obstructive sleep apnea syndrome), liver pathology, and psychosocial discomfort. [8-10]. Psoriasis is a globally widespread disease, although with a different prevalence among different populations [10]. The prevalence of psoriasis is different according to the distance from the equator [11]. In fact, a lower prevalence was observed in equatorial countries and a higher prevalence in countries at high latitudes [12]. In Western countries, it is estimated that psoriasis affects 2-4% of the population, with significant variations from country to country, from 0.91% in the United States to 8.5% in Norway [13-17]. In Italy, the prevalence is 2.9%. The prevalence is also influenced by age. In the pediatric field, it has been observed how psoriasis is less frequent in children (0.71%) and how, over the course of life, there is a progressive increase (0.37% between 0-9 years and 1.01% between 10-18 years). [18-20] A 2014 U.S. study compared the prevalence of psoriasis across ethnic groups in a 20-year-old population with the global prevalence of the disease of 3.2%, noting differences on an ethnic basis.

A cross-sectional investigation was designed to examine at how young psoriasis patients' quality of life and their families' levels of anxiety and despair are affected. One hundred five patients among the ages of 15 and 25 who had a clinical diagnosis for psoriasis were enlisted. In this study, logistic regression of patients with psoriasis were planned and analysed by SPSS, version 22.0.

The Psoriasis Area, as well as the Severity Index (PASI) were used for evaluating the severity of psoriasis. The socioeconomic index (SSI) was utilized for assessing families' socioeconomic standing. Families' income, educational attainment, work status, and occupation were obtained per SSI.

The Dermatology Life Quality Index (DLQI) along with the Family Dermatology Life Quality Index (FDLQI) were used to measure the quality of life associated with dermatology in patients and their caregivers, respectively. Ten items comprised the CDLQI, a quality-of-life tool tailored to dermatology that evaluates symptoms and emotions, leisure, education or vacations, interpersonal relationships, sleep, and treatment. Higher scores indicate a lower quality of life. A score that varies from 0 to 30 is provided. A total score that ranges from 0 to 30 is given by the FDLQI; higher values indicate a lower quality of life.

The State-Trait Anxiety Inventory in Young Patients (STAI) and the Young People's Depression Inventory (CDI) were used to assess the patient's symptoms of anxiety and depression. Higher scores indicate more severe depression symptoms. The CDI comprises a self-rated, 27-item survey with a score range of 0 to 54. For CDI, a cut-off score for 16 has been suggested. The 40 questions and two sections of the STAIC measure both trait and state anxiety. Scores vary from 20 to 60. Higher anxiety levels are indicated by higher scores.

This study found that patients with (21 – 25) years of age got 63.81%, where males were 40.95%, and females were 59.05%, 38.10 had obesity, hypertension with 8.57%, and diabetes with 5.71%, which 25.71% of patients suffered from psoriasis due to family history and demographic’s features can be identified in Table 1. According to Figure 1, localized plaque was the most common type of psoriasis, which was prevalent in patients 60%, followed by generalized plaque was the second type with 21.9%.

TABLE 1. Identification of Demographic Data at Young Patients With Psoriasis.

FIGURE 1. PSORIASIS SUBTYPES.

Severity of psoriasis is classified into mild (28.57%), moderate (50.48%), and severe (20.95%), where moderate psoriasis life stress inventory got 52.38% of all total patients, which this outcome can be defined in Table 2. Severity of psoriasis had a significantly higher effect on health and quality of life, where 19.05% had not effected, and 38.10% had a small effected of their quality of life, which it can be shown in Figure 2.

TABLE 2: Enrolment Diagnostic Data Related to the Severity of Psoriasis and its Clinical Impact on the Affected Body Surface area.

Figure 2. Determining the severity of psoriasis influence on health quality - life by dlqi scale.

Table 3. A performing of multiple questionnaires on patients with psoriasis.

In terms of the health quality of life impacted, we found that the average of DLQI was 5.7 ± 1.0, and an average of FDLQI was 10.2 ± 2.01. Based on data of logistic regression analysis, this study indicated that these factors can be described as (obesity, smoking, hypertension, Severity of psoriasis, anxiety, and depression) as most influenced on health status of patients.

TABLE 4. A logistic regression analysis of risk factors impact on health patients with psoriasis.

According to our study, psoriasis impairs the quality of life among young patients as well as their families. [21-24] Previous studies on the adult population have demonstrated that psoriasis can affect important aspects of a person's life, including family life, social interactions, education, and profession choice. In young psoriasis patients, the quality-of-life impairment caused by psoriasis has been compared to that of significant systemic illnesses consisting of coronary artery disease, cancer, and arthritis.

Patients with psoriasis can experience even greater deterioration of their quality of life due to continuous psychological development along with a lack of appropriate coping mechanisms. Also, the quality of life for young families could be impacted because therapy typically requires the presence of carers. [25]

[26-28] Previous studies have shown that psoriasis has a detrimental effect upon one's quality of life. According to a British investigation, 25 people had an average CDLQI score of 5.4. According to a few studies [29,30], 39 participants with a mean PASI score of 6.3 had an average CDLQI score of 6.15. Likewise, in a different study with 45 patients, a mean CDLQI grade of 5.05. indicated a reduction in quality of life. Patients with psoriasis had higher mean CDLQI values than those with other dermatological disorders, such as acne, urticaria, alopecia, and generalized eczema. 

According to the FDLQI, 87.8% of cohabitants from a recent study of adult psoriasis patients reported a worse quality of life. According to a Spanish study [31], psoriasis in adult patients impacts several facets of the life of spouses and families, including social disturbance, psychological strain, decline of personal relationships, and limits upon daily and leisure activities.

Psoriasis' negative impact on psychosocial development and quality of life can lead to psychological maladjustment in a number of ways. Past study [33] found a propensity of high levels for anxiety, sadness, stigmatization, and low self-esteem among juvenile psoriasis patients.

Vulnerability along with resilience are two of the numerous characteristics that influence psychological adjustment [34]. In our study, young patients of the sample exhibited greater levels of anxiety, although the severity of symptoms of depression tended to be mild. Being physically different among their classmates is a significant source of anxiety for many young people with chronic illnesses. It even becomes a significant problem, particularly across adolescents.

In conclusion, even moderate and severe cases of psoriasis negatively affect an adult's quality of life. Integrating quality-of-life assessments for psoriasis patients and their families with medical treatments may help prevent the invisible effects of psoriasis, given that challenges in school, family life, and interpersonal relationships during childhood may result in long-term consequences like psychiatric morbidities.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Kirkuk University \ College of Medicine, Kirkuk, Iraq.

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