WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Valentina et al.

World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 2.786

Volume 3, Issue 8, 1942-1948.

Research Article

ISSN 2278 – 4357

PSORIASIS INFLUENCE ON THE PATIENTS’ QUALITY OF LIFE Valentina B. Petkova1, Milen V. Dimitrov1, Irina N. Nikolova1, Christina Ch. Voycheva, Velisslava G. Valchanova MA1, Kalina G. Andreevska2 1 2

Faculty of Pharmacy, Medical University – Sofia, Bulgaria

Faculty of Pharmacy, Medical University – Plovdiv, Bulgaria.

Article Received on 15 May 2014, Revised on 12 June 2014, Accepted on 26 July 2014

ABSTRACT Background Psoriasis influences patient's lives, affecting them physically, psychologically and socially. Their quality of life is similar to that of other major medical diseases such as cancer, arthritis, hypertension,

*Correspondence for Author Professor Dr. Valentina Petkova

heart disease, diabetes and depression. The objective of this study was to evaluate QOL in psoriasis patients before and after treatment with

Faculty of Pharmacy, Medical

extemporaneous formulation. Methods: The patient’s self-assessment

University – Sofia, Bulgaria

Koo-Menter Psoriasis Instrument (A part) is applied to 22 patients suffering from different stage of psoriasis. With 0 is indicated the

absolute absence of a problem while with 10 – “very much” availability. All data were processed through SPSS 20.0 software. Chi-square test and t test were used as data analysis. Results: 22 patients were enrolled in the study. The correlation analysis of PQOL1 and PQOL2 and sex, age and duration shows that there is no significant correlation between the patients quality of life and their sex and age. But there is significant correlation between PQOL1 and the duration of the disease., Conclusions: The study showed there is improvement in QOL in psoriasis patients before and after treatment with the extemporaneous formulation. Duration of disease can be considered as a possible mediator of impact on QOL. Key words: psoriasis, quality of life, dermatology

INTRODUCTION According to NORD (National Organization for Rare Disorders), psoriasis can be classified as a rare inflammatory chronic recurrent skin disease. 125 million people worldwide - 2 to 3

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Vol 3, Issue 8, 2014.

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Valentina et al.

World Journal of Pharmacy and Pharmaceutical Sciences

percent of the total population have psoriasis, according to the World Psoriasis Day consortium. Psoriasis prevalence in African Americans is 1.3 percent compared to 2.5 percent of Caucasians. (12, 17) While in Bulgaria it is 0.2 percent to 3 percent. (9, 7) Psoriasis has a tremendous impact on patient's lives, affecting them physically, psychologically and socially. (5) Some studies showed that the impact of psoriasis on quality of life (QOL) is similar to that of other major medical disease such as cancer, arthritis, hypertension, heart disease, diabetes and depression. (11, 1, 4) Good QOL is presented when "the hopes of an individual are matched by experience". (6) The concept has been divided into several components, including psychological, social and physical domains. (13) Many psoriasis patients report moderate to extreme feelings of anxiety, anger and depression. (11) Increasing severity of psoriasis appears to correlate closely with increased severity of depression and, in turn, with higher frequency of suicidal ideation. (14, 10) QOL in dermatology is measured for clinical, scientific and financial purposes. There are plenty of QOL instruments: Psoriasis Disability Index, Medical Outcome Survey Short Form 36, Skindex-29, Dermatology Life Quality Index, Impact of Psoriasis Questionnaire, Psoriasis Life Stress Inventory, 12-item General Health Questionnaire, Koo-Menter Psoriasis Instrument. Accurate measurement of QOL is very important for guiding treatment decisions, the effect from the treatment and for assessing the possible drug-related problems. (15) On one hand – the application of QOL instrument helps the development of proper guidelines for psoriasis treatment, on the other hand – it is highly appreciated by patients who wish to express their problems, connected with the disease. (8) The Koo-Menter Psoriasis Instrument (KMPI) is a diagnostic algorithm and a formal measure. It identifies patients with significant impact on their QOL thanks to a systemic therapy. (15) In addition, the KMPI can be applied in the process of treatment decision making and for the inclusion of medication in the reimbursement list by the health care payers. The Koo–Menter Psoriasis Instrument is an easy-to-use, uniform assessment of the severity of psoriasis and its effect on quality of life. Patients complete parts, consisting of a validated measure of their quality of life (PQOL-12), a figure to illustrate the area affected by psoriasis and an assessment of subjective joint involvement. The instrument incorporates the

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Valentina et al.

World Journal of Pharmacy and Pharmaceutical Sciences

features that are generally recognized as important in the decision to institute systemic treatment for psoriasis.(2, 5, 3, 17) Therefore, the primary objective of this study was to evaluate QOL in psoriasis patients before and after treatment with traditional Bulgarian extemporaneous formulation (Pine tar, Ac. Salicylicum, Urea pura, Vehiculum). We also studied the role of demographic factors, such as age, sex and duration of disease as possible mediators of impact on QOL. METHODS The pilot study was conducted in 10 pharmacies performing extemporaneous drug formulations – Sofia, Bulgaria from March 2012 to September 2012 (6 months). This was a pharmacy-based cross-sectional representative study. Inclusion criteria was every variant of psoriasis, pre-treated or newly diagnosed. Exclusion criteria was any other kind of dermatological disease, nail psoriasis without skin involvement, sebo-psoriasis, palmoplantar pustulosis or inverse psoriasis without classical symptoms of psoriasis on the skin. Total QOL results for every patient was calculated and assessed in the beginning of the treatment with extemporaneous drug formulation and after one month of treatment. The patient’s self-assessment Koo-Menter Psoriasis Instrument (KMPI) A variant is applied to 22 patients suffering from different stage of psoriasis. Part 2 and 3 of KMPI indicates the psoriasis areas and joint involvement. With 0 is indicated the absolute absence of a problem while with 10 – “very much” availability. The patients have signed informed consent for participation in the trial. The Commission of ethics of the scientific researchers at the Medical University – Sofia has concluded that there is no need of ethical appraisal for this study as the patients only had to fill in a questionnaire and all the information is not traceable to the patient – thus guaranteeing the privacy of the participants. All data were processed through SPSS 20.0 software. Chi-square test and t test were used as data analysis. A p value less than 0.05 is considered significant. RESULTS 22 patients were enrolled in the study (12 females, 10 males). Their age ranged from 18 to 51years, average age 36,4. Duration of the disease is from 6 months to 12 years, average 3,8 years. Maximum and minimum PQOL-12 before the start of treatment were 34 and 98. Maximum and minimum PQOL-12 after the treatment were 30 and 94. (Table1 and 2)

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World Journal of Pharmacy and Pharmaceutical Sciences

The correlation analysis of PQOL1 and PQOL2 and sex, age and duration shows that there is no significant correlation between the patients quality of life and their sex and age. But there is significant correlation between PQOL1 and the duration of the disease.(Correlation is significant at the 0.01 level (2-tailed)) The results from the treatment show that there is improvement in the patient’s quality of life after two months application of the extemporaneous formulation. (Correlation is significant at the 0.05 level (2-tailed)) Table1. Demographic characteristics. No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Age 18 45 30 20 45 35 20 45 55 45 32 35 50 50 30 25 50 36 55 30 18 45

Sex m f f f f m m f m f m f m f f f m m m f m f

Duration of disease 7 3 0,5 10 12 0,5 2 2 3 0,5 4 3 2 2 3 6 1 0,5 10 4 7 3

Table 2. PQOL results before and after the treatment with the extemporaneous formulation. No 1 2 3 4 5 6 7 www.wjpps.com

PQOL1 46 68 65 68 54 85 98 Vol 3, Issue 8, 2014.

PQOL2 42 60 64 68 48 80 86 1945

Valentina et al.

World Journal of Pharmacy and Pharmaceutical Sciences

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Average

45 34 42 85 54 85 90 71 52 53 67 77 40 82 92 66,05

50 30 46 82 50 90 88 71 52 52 60 72 40 80 94 63,86

DISCUSSION Psoriasis is a serious dermatological disease and is associated with significantly lower QoL. Pharmacological interventions along with patient counseling and education may be an effective strategy to improve QoL among psoriasis patients. The study showed there is improvement in QOL in psoriasis patients before and after treatment with the extemporaneous formulation, based on Pine tar, Ac. Salicylicum, Urea pura. Duration of disease can be considered as a possible mediator of impact on QOL. CONCLUSIONS This research may serve as a stimulus to better understand this communication and to use more aggressive treatment options. Moreover, the findings from this study indicate that KMPI is an appropriate tool for the medical professionals to evaluate the impact of this disease on a patient’s quality of life and to ensure adequate therapeutic intervention. REFERENCES 1. Akay A, Pekcanlar A, Bozdag KE, Altintas L, Karaman A. Assessment of depression in subjects with psoriasis vulgaris and lichen planus. J Eur Acad Dermatol Venereol 2002; 16:347-52. 2. Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R. Quality of life in patients with psoriasis. Health Qual Life Outcomes 2006; 4: 35. 3. Calman KC. Quality of life in cancer patients-hypothesis. J Med Ethics 1984; 10:124-7.

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4. Dubertret L, Mrowietz U, Ranki A, van de Kerkhof PC, Chimenti S, Lotti T, Schäfer G. EUROPSO Patient Survey Group. European patient perspectives on the impact of psoriasis: The EUROPSO patient membership survey. British Journal of Dermatology 2006; 155:729-736. 5. Feldman SR, Koo JY, Menter A, Bagel J. Decision points for the initiation of systemic treatment

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17. Statistics

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