OBJECTIVES: Most dermatological conditions fall under visible skin diseases (VSDs), where lesions are exposed and readily seen, increasing patients' risk of experiencing external stigma from the public and specific professional groups (e.g., service providers). This stigma imposes psychological and social burdens that far exceed the psychological symptoms of the disease. To date, no systematic research has been conducted in China specifically on the external stigma associated with VSDs. Taking psoriasis, vitiligo, and acne as representative conditions, this study aims to explore the external stigma experienced by VSD patients across various social settings and to provide a scientific foundation for the development of measurement tools, quantitative research, and targeted interventions. METHODS: A purposive sample of 23 outpatients diagnosed with psoriasis, acne, or vitiligo was recruited from the Xiangya Hospital Dermatology Clinic of Central South University between December 2023 and July 2024. In-depth qualitative interviews were conducted. Data were analyzed using Mayring's qualitative content analysis and thematic analysis. Reporting followed the Consolidated Criteria for Reporting Qualitative Research guidelines. The interviews focused on the experience of external stigma across different social settings. RESULTS: Patients with VSDs reported experiencing external stigma in various contexts including family, community, recreational service venues, healthcare institutions, and others. The main motivation behind stigmatizing behaviors was disease avoidance (e.g., fear of contagion, aversion, social distancing). Stigmatization in school settings was also reported by patients with all 3 types of VSDs. Psoriasis patients reported stigma across all examined scenarios, while vitiligo and acne patients reported stigma in only some contexts. CONCLUSIONS Patients with VSDs experience significant external stigma, with psoriasis patients facing a higher burden compared to those with vitiligo or acne. The predominant stigma-driving factor is the public's desire to avoid disease, which underscores the need for public education to correct misconceptions about VSDs. External stigma from family, school, social networks, healthcare providers, and structural stigma should be the focus of policy and intervention efforts aimed at protecting the rights and well-being of patients with VSDs.
Humans ; Social Stigma ; Female ; Male ; Qualitative Research ; Acne Vulgaris/psychology* ; Skin Diseases/psychology* ; Adult ; Psoriasis/psychology* ; Vitiligo/psychology* ; Middle Aged ; China ; Young Adult

Background: Psoriasis is a chronic immune-mediated, multisystem inflammatory skin disease that can profoundly impact the quality of life (QoL) of both patients and their families. This study aimed to analyse the impact of psoriasis on the QoL of patients’ family members and its association with anxiety and depression. Methods: This was a cross-sectional study which had a total of 240 subjects (80 patients, 80 family members, and 80 healthy controls). The Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the QoL of patients, and the Family Dermatology Life Quality Index (FDLQI) questionnaire was used to assess the QoL of family members. In addition, the Hospital Anxiety and Depression Scale (HADS) was used to evaluate the state of anxiety or depression of all subjects, including the healthy controls. Results: Up to 82.5% of family members of psoriasis patients had impaired QoL (FDLQI ≥2). The mean DLQI was 8.89±7.58, whereas the mean FDLQI scores was 7.58±6.09, showing the considerable impact of psoriasis on both patients and family members’ quality of life. There was a positive correlation between family members’ QoL with patients’ anxiety (rs =0.348; p=0.002) and depression (rs =0.276; p=0.013) level. However, no association was found between family members’ QoL with patients’ psoriasis severity (rs =0.173; p=0.126) and the DLQI scores (rs =0.137; p=0.224). Based on the HADS, the mean anxiety scores was 5.29±4.07 and the mean depression scores was 4.54±4.20 for family members. An anxiety disorder was suggested in 32.5%, while depression was suggested in 23.8% of family members. Conclusion Psoriasis has a significant impact on both patients and their family members, who experienced impairment of their QoL and higher levels of anxiety and depression.
Psoriasis ; Quality of Life--psychology

Background: Psoriasis vulgaris is a chronic immune-mediated inflammatory multi-system disease characterised by keratinocyte hyperproliferation. Data regarding patients’ disease severity, knowledge and quality of life (QOL) is important to optimize treatment strategies for psoriasis. This study aims to evaluate and investigate the relationship between disease severity, knowledge and QOL of patients with psoriasis. Methods: A cross-sectional multicentre study utilizing a socio-demographic data collection form, Psoriasis Knowledge Assessment Questionnaire (PKAQ), Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI was conducted. Correlations between PKAQ, DLQI and PASI were analysed using Spearman’s test. Results: A total of 114 subjects participated in this study. Majority of them had mild psoriasis (n=73, 64%) based on PASI. The mean score of PKAQ was fourteen out of a total possible score of twenty-five, whereas the DLQI had a non-parametric distribution with a median (interquartile range) of 7 (10). Most subjects (32.5%) stated that psoriasis had a ‘moderate effect’ on their QOL, while only 3.5% said that it had an ‘extremely large effect’ on their QOL. There was a statistically significant correlation between PASI and DLQI (rs = 0.264, p = 0.004), with higher PASI scores corresponding to higher DLQI scores. No statistically significant correlation was found between DLQI and PKAQ (rs = -0.048, p= 0.612), and between PASI and PKAQ (rs = 0.058, p= 0.542). Conclusion Impairment of QOL was positively associated with severity of psoriasis. However, there was no significant relationship between knowledge and quality of life, as well as between knowledge and psoriasis severity.
Psoriasis--diagnosis ; Patient Acuity ; Quality of Life--psychology ; Patient Health Questionnaire

INTRODUCTION: Psoriasis is a chronic inflammatory disease with a global prevalence of approximately 2% and significant psychiatric comorbidity. There is a great deal of existing literature assessing different aspects of psychology in psoriasis. We aimed to conduct an in-depth review of current evidence linking psoriasis to personality traits and psychiatric comorbidities, as well as factors that put these patients at risk of psychopathology. MATERIALS AND METHODS: A search of the PubMed database identified 1632 articles. We included articles studying psychological comorbidity in patients with psoriasis, looking especially at personality characteristics, and data linking psoriasis with increased risks of psychological distress, depression, anxiety and suicidality. In particular, we also evaluated subgroups in psoriasis found to be at risk. RESULTS: Patients with psoriasis are more likely to be alexithymic, lack body awareness and possess a Type D personality. Alcohol, but not illicit drug use, disorders are also more common in patients with psoriasis. Patient groups who are especially at risk of psychological distress include women, younger patients, patients with a younger age of disease onset, those who self-assess their psoriasis to be severe, and those with lesions on visible or sensitive areas. Adopting motivational interviewing skills and incorporating the use of learning materials during consultations have been found to be useful. CONCLUSION The knowledge of personality characteristics, "at-risk" groups, and early recognition of psychological distress among patients with psoriasis can help clinicians provide better holistic care and encourage a change in patients' behaviour.
Affective Symptoms ; epidemiology ; psychology ; Age Factors ; Age of Onset ; Alcoholism ; epidemiology ; psychology ; Anxiety ; epidemiology ; psychology ; Comorbidity ; Depression ; epidemiology ; psychology ; Humans ; Mental Disorders ; epidemiology ; psychology ; Motivational Interviewing ; Personality ; Psoriasis ; epidemiology ; psychology ; Sex Factors ; Stress, Psychological ; epidemiology ; psychology ; Substance-Related Disorders ; epidemiology ; psychology ; Suicidal Ideation ; Type D Personality

OBJECTIVESince the dermatology life quality index (DLQI), a self-administered general dermatology quality of life instrument, was originally developed and published in a dermatology clinic at University hospital of Wales, our goal was to popularize the disease-specific scale used in measuring the quality of life of patients with skin diseases and to assess the reliability and validity of its Chinese version.

METHODSWe administered the DLQI to 236 out-patients attending our dermatology clinic and results that had been found by those who originated the DLQI, were examined. The reliability and validity of DLQI were assessed by means of reliability analysis and factor analysis.

RESULTSOverall, the DLQI seemed easy to administer and could be completed within 3 minutes. The internal consistency coefficient rates of this unidimensional measure were 0.87 (Cronbach's alpha) and 0.85 (Spearman-brown, s) with high inter-correlations found between the dimensions with a correlation coefficient ranging from 0.4024 - 0.6569. Factor analysis resulted in a unidimensional pattern, which supported the use of a total DLQI-C score.

CONCLUSIONDLQI was an easy and efficient instrument for assessing the quality of life in patients with dermatological problems and with better reliability and validity. Thus, it could be used in both research and clinical settings in China.

Eczema ; psychology ; Female ; Humans ; Male ; Psoriasis ; psychology ; Quality of Life ; Reproducibility of Results ; Sickness Impact Profile ; Skin Diseases ; psychology ; Surveys and Questionnaires

Annular pustular psoriasis is a rare variant of the generalized pustular psoriasis characterized by subacute onset of annular lesions with pustules on the advancing edge. Compared with the Zumbusch type, annular type is less severe and has a more benign course, and it is known to respond more rapidly to therapy. Histologically, spongiform pustules are seen in the epidermis and discrimination from subcorneal pustular dermatosis may be difficult. We report four cases of annular pustular psoriasis. Two cases were adult female patients who had been given long-term systemic corticosteroid therapy. In the other two patients who were a 9-year-old female and a 10-year-old male respectively, we could not find any provocating factor of pustular psoriasis. There was a past history of psoriasis vulgaris in three cases, although none had any family history of psoriasis.
Adult ; Child ; Discrimination (Psychology) ; Epidermis ; Female ; Human papillomavirus 16* ; Humans ; Immunotherapy* ; Male ; Psoriasis ; Skin Diseases, Vesiculobullous