Impact of challenging-to-treat areas on quality of life and mental health among plaque psoriasis patients from Sabah, Malaysia.

Introduction: Patients with psoriasis with involvement of challenging-to-treat-areas often have higher disease burden. We studied the impact of the challenging-to-treat areas namely scalp, face, nail, palms, soles and genitalia on the quality of life and mental health of psoriatic patients.

Materials and methods: We conducted a cross-sectional study involving 120 patients aged 18 years and above with plaque psoriasis. Those with challenging-to-treat-areas were compared to those without.

Results: The prevalence of challenging-to-treat-areas were scalp (35.8%), face (26.7%), nails (38.3%), palms (6.7%), soles (5.0%) and genitalia (15.0%). Psoriasis Area and Severity Index (PASI) was higher in patients with challenging-to-treat areas, with a median of 4.55 (IQR: 3.00, 7.80) compared to 1.80 (IQR: 0.60, 2.85) in those without (p < 0.001). Patients with these areas demonstrated a significantly higher Disease Life Quality Index (DLQI) scores compared to those without (mean ± SD: 5.13 ± 6.17 vs 11.02 ± 7.19; p < 0.001). Overall the prevalence of depression, anxiety and stress, scored using Depression, Anxiety and Stress Scale-21 Item (DASS-21), were 19.2%, 28.3% and 14.2% respectively with two thirds of patients had challenging-to-treat areas. Significantly more patients with challenging-to-treat-areas suffered from moderate to extremely severe depression (8.4% vs 5.0%, p = 0.034) and anxiety (33.4% vs 16.7%, p = 0.001). Patients with challenging-to-treat areas had higher mean itch Numeric Rating Scale (NRS) (4.28 ± 2.90) compared to those without (1.45 ± 1.58) (p < 0.001).

Conclusion: Patients with psoriasis with challenging-totreat- areas reported greater impairment in quality of life and higher risk of depression and anxiety.