Increased Trend of Cosmetic Procedures in Patients With Psoriasis Who Attain 75% or Greater Improvement

August 2020 | Volume 19 | Issue 8 | Original Article | 698 | Copyright © August 2020


Published online July 31, 2020

doi:10.36849/JDD.2020.5104R1

Michelle E. Walters MD,a Delphine J. Lee MD PhD,a,b,c Paul S. Yamauchi MD PhDc,d

aDivision of Dermatology, Department of Medicine, Harbor- UCLA Medical Center, Torrance, CA bThe Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA cDivision of Dermatology David Geffen School of Medicine at UCLA, Los Angeles, CA dDermatology Institute and Skin Care Center, Santa Monica, CA

Abstract
Background: The relationship between the clearance of psoriasis and improved quality of life together with an increased uptake of cosmetic procedures has not been reported to date.
Objective: A survey was conducted at a single dermatology center to determine if there was an increased trend in cosmetic procedures in patients with moderate to severe psoriasis who attained 75% or greater reduction of the body surface area (BSA) with biologic agents and oral systemic therapies, and if this was related to an improvement in quality of life following psoriasis clearance.
Study Design: In this case series, 138 patients with a history of moderate to severe psoriasis who attained 75% or greater body surface area (BSA) reduction with biologic agents or oral systemic therapies and had undergone at least one cosmetic procedure in the past 2 years were surveyed. Patient characteristics were collected including age, sex, percent BSA at initiation of therapy, the class of biologic or oral systemic therapies, and the different types of cosmetic procedures. Patients were asked to answer a 5-question survey on quality of life improvement, satisfaction with treatment, and correlation with the cosmetic procedure they had undergone, Patients also completed the Dermatology Quality of Life Index (DLQI) questionnaire in the survey.
Results: The majority of patients who had undergone a cosmetic procedure after achieving 75% BSA stated that their psoriasis had previously prevented them from undergoing a cosmetic procedure. Regardless of therapy, all patients felt their quality of life had improved as a result of their treatment, and 91% of patients stated this was the impetus to undergo a cosmetic procedure. The mean DLQI score prior to therapy was 14.3 and 71% of patients reported a DLQI score of 0/1 after their psoriasis improved.
Conclusion: There was a correlation between improvement in quality of life in patients who had achieved at least a 75% reduction in BSA with either a biologic agent, oral agent, or both, and the uptake of cosmetic procedures.

J Drugs Dermatol. 2020;19(8): doi:10.36849/JDD.2020.5104R1

INTRODUCTION

Psoriasis is a chronic skin condition with a negative impact on patient quality of life. The National Psoriasis Foundation states that an acceptable response to psoriasis treatment is at least a 75% reduction in body surface area (BSA) at 3 months after initiation of treatment.1 This reduction in BSA has been associated with improvement in quality of life, with clearance rates of clear to almost clear leading to an even greater improvement in quality of life.2,3 To date, there have been no studies examining the relationship between improvement in quality of life following a reduction in BSA, and the increased utilization of cosmetic procedures. Here, we examine the relationship between quality of life and the use of various cosmetic procedures in patients treated for psoriasis with systemic and biologic therapies who achieved at least 75% reduction in BSA.

METHODS

This was a retrospective study assessing quality of life and the use of cosmetic procedures in psoriasis patients after attaining a75% or greater reduction of the body surface area with biologic agents only, systemic agents only, or a combination of both. This study was conducted according to the ethical guidelines of the 1975 Declaration of Helsinki. All patients provided informed consent.

A chart review was conducted at a single dermatology center (Dermatology Institute and Skin Care Center, Santa Monica CA) and 138 patients were included in this study. All patients surveyed had a history of moderate to severe psoriasis, had attained 75% or greater BSA reduction with biologic agents or oral systemic therapies, and had undergone at least one cosmetic procedure in the past 2 years. Patient characteristics were collected including age, sex, present BSA at time of survey, history of treatment with biologic or oral systemic therapies, and types of cosmetic procedures undergone.

Patients completed the Dermatology Life Quality Index (DLQI)
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