Related Experiment Video
Updated: Jan 3, 2026
Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Association Between Quality of Life and Improvement in Psoriasis Severity and Extent in Pediatric Patients
Finola M Bruins1, Inge M G J Bronckers1, Hans M M Groenewoud2
1Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Insights
Significant psoriasis clearance, defined as a 90% or greater improvement in the Psoriasis Area Severity Index (PASI) and body surface area (BSA), is linked to the greatest quality of life (QOL) improvements in children. Systemic treatments also showed better QOL outcomes.
Area of Science:
- Pediatric Dermatology
- Quality of Life Research
- Clinical Trial Analysis
Background:
- Psoriasis treatment improves quality of life (QOL) but the link between clearance degree and QOL in pediatric patients is understudied.
- Understanding this association is crucial for optimizing treatment strategies in children with psoriasis.
Purpose of the Study:
- To determine the association between psoriasis improvement (PASI and BSA response) and QOL (CDLQI) in pediatric psoriasis patients.
- To evaluate if treatment type impacts QOL independently of psoriasis clearance.
Main Methods:
- A single-center, prospective, observational cohort study (Child-CAPTURE registry) analyzed data from children (<18 years) with psoriasis.
- Included treatment episodes with Children's Dermatology Life Quality Index (CDLQI), Psoriasis Area Severity Index (PASI), and Body Surface Area (BSA) scores.
- Treatments were categorized as topical, dithranol, conventional systemic, or biological.
Main Results:
- A total of 319 pediatric patients were analyzed.
- The most significant QOL improvements were observed with PASI ≥90 (mean CDLQI change -6.6) and BSA ≥90 (mean CDLQI change -6.8) response categories.
- Systemic treatments led to greater QOL improvements compared to topical treatments, irrespective of PASI response.
Conclusions:
- Achieving PASI 90 or greater and ≥90% BSA involvement reduction are associated with substantial QOL gains in pediatric psoriasis.
- These clearance levels may represent clinically meaningful goals for optimizing QOL in children.
- Systemic therapies show a stronger association with QOL improvement than topical treatments in this population.
Importance:
Treatment of psoriasis is associated with improved quality of life (QOL) in those with the disease. However, in daily clinical practice, the association between the degree of psoriasis clearance and QOL has not been studied to date, especially in the pediatric population.
Objectives:
To identify the association between the degree of psoriasis improvement (as measured by the Psoriasis Area Severity Index [PASI] and body surface area [BSA] response) and QOL (as measured by the Children's Dermatology Life Quality Index [CDLQI]) in pediatric psoriasis, and to assess the association of treatment type with QOL, independent of psoriasis improvement.
Design, Setting, And Participants:
Data used in this single-center cohort study were extracted from the Child-CAPTURE (Continuous Assessment of Psoriasis Treatment Use Registry), a prospective, observational, daily clinical practice cohort of all children (aged <18 years) with a psoriasis diagnosis who attended the outpatient clinic of the Department of Dermatology at the Radboud University Medical Center in Nijmegen, the Netherlands, between September 3, 2008, and May 4, 2018. All records of treatment episodes with CDLQI, PASI, and BSA scores were included in the analysis.
Exposures:
Patients were treated according to daily clinical care. Treatments were clustered into topical, dithranol, conventional systemic, and biological treatments. Because of low numbers of UV-B phototherapy, this treatment was not assessed.
Main Outcomes And Measures:
Primary outcomes were mean change of CDLQI scores per PASI and BSA response categories (0 to <50, 50 to <75, 75 to <90, and ≥90) and mean CDLQI change per treatment categories.
Results:
In total, 319 patients (median [interquartile range] age, 10.0 [7.0] years; 183 female [57.4%]) were analyzed for PASI score improvement (399 treatment episodes) and improvement in BSA involvement (366 treatment episodes). The greatest improvements in CDLQI scores were seen in the PASI ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.6 (95% CI, -7.5 to -5.7). The greatest improvements in CDLQI scores were also observed in the BSA ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.8 (95% CI, -7.5 to -6.1). Systemic treatment demonstrated a greater degree of improvement of CDLQI compared with topical treatment, independent of PASI response categories.
Conclusions And Relevance:
This cohort study in a real-world setting found that the greatest improvements in QOL were associated with PASI 90 or greater, a decrease in BSA involvement of 90% or greater, and systemic treatments. These findings suggest that reaching PASI 90 or greater and decreasing BSA involvement by at least 90% may be clinically meaningful treatment goals that will help pediatric patients with psoriasis reach optimal QOL.
