Psycho-cognitive Aspects of Disease Correlate Stronger with Quality of Life Impairment Compared to Objective Disease Severity

The impact of chronic dermatological conditions on quality of life (QoL) is well established. Although novel therapies are increasingly efficacious, they are not financially accessible for many, highlighting the importance of “living well” with disease. This current study aims to assess the relative importance of psychosocial and objective factors in influencing QoL impairment. An interim secondary analysis was conducted on 578 outpatient adult patients prospectively recruited from two tertiary dermatological centres in Singapore. All participants were assessed by a dermatologist and completed a self- administered questionnaire. 415 eczema and 163 psoriasis patients were recruited. Mean body surface area was 7.26% (SD 12.4, range 9-80) for eczema and 7.05% (SD 9.4, range 0-60) for psoriasis patients. The mean skindex-16 score (measure of QoL) was 55.5% (SD 26.7, range 0-100). Factors with the highest correlation with impaired QoL were anxiety (correlation coefficient 0.54), emotional representation of disease (0.59) and negative social comparison (0.41). In contrast, objective severity (BSA*IGA/PGA) had a weaker correlation of 0.24. Multivariable regression showed that anxiety, negative social comparison, cyclical disease course, lack of treatment control, lack of illness coherence, having eczema (compared to psoriasis) and increased objective disease severity were associated with greater QoL impairment. This study explains why patients with the same observed disease state can have differing symptom burden and highlights the psychosocial factors contributing to symptom burden that can be addressed in clinical practice and future research. Limitations include the lack of statistical controlling for patient’s age and gender.