Clinical Assessment and Psychosocial Impact of Psoriasis

presence of alexithymia defined as 20-item Toronto Alexithymia Scale (TAS-20) score ≥61: TAS-20 is a validated self-report scale that is comprised of 20 items. Items are rated using a 5-point Likert scale: 1 = strongly disagree, 2 = neither agree or disagree, 3 = undecided, 4 = agree, 5 = strongly agree. There are 3 subscales: difficulty describing feelings, difficulty identifying feelings, and externally oriented thinking. The total alexithymia score is the sum of responses to all 20 items, while the score for each subscale factor is the sum of the responses to that subscale. The TAS-20 uses cutoff scoring: equal to or less than 51 = non-alexithymia, equal to or greater than 61 = alexithymia. Scores of 52 to 60 = possible alexithymia.

Psoriasis Global Assessment (PGA): Overall lesions are graded for induration (from 0 = no evidence of plaque elevation to 5 = severe plaque elevation = 1.25 mm or more), erythema (from 0 = no evidence of erythema, hyperpigmentation may be present to 5 = dusky to deep red coloration), and scaling (from 0 = no evidence of scaling to 5 = severe; very thick tenacious scale predominates). The sum of the 3 scales is divided by 3 and rounded to obtain a final PGA score. The PGA final scores are defined as: 0 = cleared, except for residual discoloration; 1 = minimal; 2 = mild; 3 = moderate; 4 = marked; and 5 = severe.

Psoriasis Area and Severity Index (PASI): system used for assessing and grading the severity of psoriatic lesions and their response to therapy. The PASI produces a numeric score that can range from 0 to 72. A PASI 50 response is defined as ≥50% improvement in PASI score from baseline; PASI 75 and PASI 90 are similarly defined.

Hospital Anxiety and Depression Scale (HADS; subscales: anxiety [-A], depression [-D]) is a validated 14-item scale with 7 of the items relating to anxiety and 7 relating to depression. Each item is scored from 0 to 3, with higher scores indicating greater likelihood of depression or anxiety. Cases of anxiety or depression are each defined by subscale scores of 8 or greater, and categorized as normal (score of 0 to 7), mild (score of 8 to 10), moderate (score of 11 to 14), and severe (score of 15 to 21). The recall period is the past week.

Alcohol Use Disorders Identification Test (AUDIT) consists of 10 questions about a patient's quantity and frequency of alcohol use. The response to 8 of the questions are scored as 0 = never, 1 = monthly or less, 2 = 2 to 4 times a month, 3 = 2 to 3 times a week, 4 = 4 or more times a week. Two questions are scored as 0 = no, 2 = yes, but not in the last year, 4 = yes, during the last year. A score of 8 or more is associated with harmful or hazardous drinking. In this study, the patient self-report questionnaire will be used

number of cigarettes smoked per day

Dermatology Life Quality Index (DLQI) is a dermatology-specific validated 10-question quality of life instrument. Each question addresses how much the patient's skin problem has affected their life and is scored as: 3 = very much, 2 = a lot, 1 = a little, 0 = not at all, or 0 = not relevant. The recall period is the past week. The DLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0. The higher the score, the more health-related quality of life is impaired: 0 to 1 = no effect at all on patient's life; 2 to 5 = small effect on patient's life; 6 to 10 = moderate effect on patient's life; 11 to 20 = very large effect on patient's life; 21 to 30 = extremely large effect on patient's life.

Work Productivity and Activity Impairment questionnaire:Psoriasis (WPAI:PSO) produces 4 types of scores: absenteeism (work time missed), presenteeism (impairment at work/reduced on-the-job effectiveness), work productivity loss (overall work impairment/absenteeism plus presenteeism), and activity impairment. The WPAI:PSO outcomes are expressed as impairment percentages, with higher numbers indicating greater impairment and less productivity, ie, worse outcomes.