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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aims of this study were to determine the impact of psoriasis on patient quality of life&#44; to analyze differences in perception between patients and physicians regarding quality of life&#44; treatment satisfaction&#44; and patient needs&#44; and to assess the physician-patient relationship&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multicenter&#44; observational&#44; cross-sectional study was undertaken in which a representative group of dermatologists&#8211;working in hospitals and outpatient clinics throughout Spain&#8211;and their patients with a diagnosis of psoriasis completed specifically designed questionnaires&#46; The questionnaires covered patient demographics&#44; disease characteristics&#44; impact of the disease on quality of life&#44; treatment of psoriasis&#44; and the relationship between patient and dermatologist&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 151 dermatologists from throughout Spain included a mean of 5 patients each&#46; The analysis included 771 questionnaires completed by dermatologists and 732 completed by patients&#46; Two-thirds of patients had moderate-to-severe psoriasis with a major impact on quality of life&#44; particularly in relation to emotional wellbeing&#46; Nevertheless&#44; quality of life was only assessed routinely and systematically by 19&#46;9&#37; of dermatologists&#46; Overall&#44; 47&#37; of patients reported being quite satisfied or very satisfied with the treatment they received&#46; No significant differences were observed between patients and dermatologists on the aspects analyzed&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our results highlight the substantial impact of psoriasis on patient quality of life and the consequent need for systematic quality-of-life assessment in affected patients&#46; Patients reported a high level of satisfaction with the care provided by dermatologists and the treatment received&#46; There was good agreement between patients and dermatologists in their assessment of the variables analyzed&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue evaluar el impacto de la psoriasis en la calidad de vida del paciente&#44; las diferencias entre m&#233;dicos y pacientes en las percepciones sobre la calidad de vida&#44; los tratamientos y las necesidades de los pacientes y la relaci&#243;n m&#233;dico-paciente&#46;</p> <span class="elsevierStyleSectionTitle">Material and m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; multic&#233;ntrico&#44; de corte transversal&#44; en el cual un grupo de dermat&#243;logos representativos de toda la geograf&#237;a espa&#241;ola&#44; con ejercicio tanto en el &#225;mbito hospitalario como ambulatorio&#44; y de pacientes con diagn&#243;stico de psoriasis&#44; cumplimentaron una encuesta especialmente dise&#241;ada para el estudio&#46; La encuesta inclu&#237;a preguntas sobre datos demogr&#225;ficos del paciente&#44; caracter&#237;sticas de la enfermedad&#44; impacto de esta sobre la calidad de vida&#44; manejo terap&#233;utico de la psoriasis y relaci&#243;n paciente-dermat&#243;logo&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Un total de 151 dermat&#243;logos de toda Espa&#241;a incluyeron una media de 5 pacientes cada uno&#46; Se incluyeron en el an&#225;lisis un total de 771 encuestas cumplimentadas por los dermat&#243;logos y 732 encuestas cumplimentadas por los pacientes&#46; Dos terceras partes de los pacientes presentaban una enfermedad moderada a grave con una importante repercusi&#243;n en la calidad de vida&#44; en especial sobre el estado emocional&#46; No obstante&#44; la calidad de vida s&#243;lo era evaluada de forma sistem&#225;tica y rutinaria por el 19&#44;9&#37; de los dermat&#243;logos&#46; El 47&#37; de los pacientes estaba muy satisfecho o bastante satisfecho con el tratamiento que recib&#237;a&#46; No se encontraron diferencias relevantes entre las percepciones del paciente y del m&#233;dico sobre los aspectos evaluados&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados se&#241;alan el importante impacto que tiene la psoriasis sobre la calidad de vida del paciente y la necesidad de evaluar este par&#225;metro de forma sistem&#225;tica&#46; Los pacientes refieren un buen grado de satisfacci&#243;n con la atenci&#243;n recibida por los dermat&#243;logos y los tratamientos administrados&#46; Existe bastante concordancia entre los pacientes y los dermat&#243;logos en la valoraci&#243;n de los par&#225;metros evaluados&#46;</p>"
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                      "titulo" => "The prevalence of psoriasis in the world"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;P&#46; Raychaudhuri"
                            1 => "E&#46;M&#46; Farber"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "volumen" => "15"
                        "paginaInicial" => "16"
                        "paginaFinal" => "17"
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                      "titulo" => "Prevalence of psoriasis in Spain &#40;Epiderma Project&#58; phase I&#41;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "X&#46; Bordas"
                            2 => "V&#46; Garc&#237;a-Patos"
                            3 => "S&#46; Puig"
                            4 => "R&#46; Pujol"
                            5 => "A&#46; Smand&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "paginaFinal" => "23"
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                        "fecha" => "2005"
                        "volumen" => "23"
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                        "paginaFinal" => "694"
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                          ]
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                ]
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                        "paginaFinal" => "329"
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                      "titulo" => "Depression and suicidal ideation in dermatology patients with acne&#44; alopecia areata&#44; atopic dermatitis and psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;A&#46; Gupta"
                            1 => "A&#46;K&#46; Gupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "1998"
                        "volumen" => "139"
                        "paginaInicial" => "846"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9892952"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and correlates of suicidal ideation among patients with skin disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Picardi"
                            1 => "E&#46; Mazzotti"
                            2 => "P&#46; Pasquini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2005.11.1103"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2006"
                        "volumen" => "54"
                        "paginaInicial" => "420"
                        "paginaFinal" => "426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16488292"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Poikolainen"
                            1 => "J&#46; Karvonen"
                            2 => "E&#46; Pukkala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1999"
                        "volumen" => "135"
                        "paginaInicial" => "1490"
                        "paginaFinal" => "1493"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10606054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity&#44; smoking&#44; and psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Lebwhol"
                            1 => "J&#46;P&#46; Callen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2006"
                        "volumen" => "295"
                        "paginaInicial" => "208"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16715548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Mallbris"
                            1 => "O&#46; Akre"
                            2 => "F&#46; Granath"
                            3 => "L&#46; Yin"
                            4 => "B&#46; Lindel&#246;f"
                            5 => "A&#46; Ekbom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Epidemiol"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "225"
                        "paginaFinal" => "230"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15117115"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;G&#46; Fortune"
                            1 => "H&#46;L&#46; Richards"
                            2 => "B&#46; Kirby"
                            3 => "K&#46; McElhone"
                            4 => "T&#46; Markham"
                            5 => "S&#46; Rogers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archderm.139.6.752"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2003"
                        "volumen" => "139"
                        "paginaInicial" => "752"
                        "paginaFinal" => "756"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12810506"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The direct cost of care for psoriasis and psoriatic arthritis in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;S&#46; Javitz"
                            1 => "M&#46;M&#46; Ward"
                            2 => "E&#46; Farber"
                            3 => "L&#46; Nail"
                            4 => "S&#46;G&#46; Vallow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2002"
                        "volumen" => "46"
                        "paginaInicial" => "850"
                        "paginaFinal" => "860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12063481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The negative impact of psoriasis on the workplace"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;J&#46; Pearce"
                            1 => "S&#46; Singh"
                            2 => "R&#46; Balkrishnan"
                            3 => "A&#46; Kulkarni"
                            4 => "A&#46;B&#46; Fleischer"
                            5 => "S&#46;R&#46; Feldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/09546630500482886"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatolog Treat"
                        "fecha" => "2006"
                        "volumen" => "17"
                        "paginaInicial" => "24"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16467020"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in patients with psoriasis&#58; a systematic literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; de Korte"
                            1 => "M&#46;A&#46; Sprangers"
                            2 => "F&#46;M&#46; Mombers"
                            3 => "J&#46;D&#46; Bos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1087-0024.2003.09110.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Investig Dermatol Symp Proc"
                        "fecha" => "2004"
                        "volumen" => "9"
                        "paginaInicial" => "140"
                        "paginaFinal" => "147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15083781"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1552526010000828"
                          "estado" => "S300"
                          "issn" => "15525260"
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                      ]
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                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis--an index of disability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;Y&#46; Finlay"
                            1 => "S&#46;E&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Exp Dermatol"
                        "fecha" => "1987"
                        "volumen" => "12"
                        "paginaInicial" => "8"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3652510"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1552526010001032"
                          "estado" => "S300"
                          "issn" => "15525260"
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                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of severe psoriasis on the quality of life of 369 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;Y&#46; Finlay"
                            1 => "E&#46;C&#46; Coles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "1995"
                        "volumen" => "132"
                        "paginaInicial" => "236"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7888360"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1552526009000570"
                          "estado" => "S300"
                          "issn" => "15525260"
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                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis causes as much disability as other major medical diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;R&#46; Rapp"
                            1 => "S&#46;R&#46; Feldman"
                            2 => "M&#46;L&#46; Exum"
                            3 => "A&#46;B&#46; Fleischer"
                            4 => "D&#46;M&#46; Reboussin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1999"
                        "volumen" => "41"
                        "numero" => "3 Pt 1"
                        "paginaInicial" => "401"
                        "paginaFinal" => "407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10459113"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Nacional Psoriasis Foundation&#46; Spring 2007 Survey Panel Snapshot&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://psoriasis.org/files/pdfs/research/2007_%20spring_survey_panel.pdf">http&#58;&#47;&#47;psoriasis&#46;org&#47;files&#47;pdfs&#47;research&#47;2007&#95;spring&#95;survey&#95;panel&#46;pdf</a>&#46;&#40;last accessed January 14&#44; 2008&#41;&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis is common&#44; carries a substantial burden even when not extensive&#44; and is associated with widespread treatment dissatisfaction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;S&#46; Stern"
                            1 => "T&#46; Nijsten"
                            2 => "S&#46;R&#46; Feldman"
                            3 => "D&#46;J&#46; Margolis"
                            4 => "T&#46; Rolstad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1087-0024.2003.09102.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Investig Dermatol Symp Proc"
                        "fecha" => "2004"
                        "volumen" => "9"
                        "paginaInicial" => "136"
                        "paginaFinal" => "139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15083780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis has a major secondary impact on the lives of family members and partners"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;M&#46; Eghlileb"
                            1 => "E&#46;E&#46; Davies"
                            2 => "A&#46;Y&#46; Finlay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2007.07881.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "156"
                        "paginaInicial" => "1245"
                        "paginaFinal" => "1250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17459044"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El impacto psicosocial de la psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; S&#225;nchez-Rega&#241;a"
                            1 => "R&#46; Ojeda-Cuchillero"
                            2 => "I&#46; Umbert-Millet"
                            3 => "P&#46; Umbert-Millet"
                            4 => "W&#46; Lupo"
                            5 => "J&#46; Sol&#233;-Fern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2003"
                        "volumen" => "94"
                        "paginaInicial" => "11"
                        "paginaFinal" => "16"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impacto de la psoriasis en la calidad de vida del paciente espa&#241;ol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Ribera"
                            1 => "G&#46; Caball&#233;"
                            2 => "N&#46; Fern&#225;ndez-Chico"
                            3 => "M&#46;J&#46; Fuente"
                            4 => "C&#46; Ferr&#225;ndiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "242"
                        "paginaFinal" => "249"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European patient perspectives on the impact of psoriasis&#58; the EUROPSO patient membership survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Dubertret"
                            1 => "U&#46; Mrowietz"
                            2 => "A&#46; Ranki"
                            3 => "P&#46;C&#46; van de Kerkhof"
                            4 => "S&#46; Chimenti"
                            5 => "T&#46; Lotti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07405.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2006"
                        "volumen" => "155"
                        "paginaInicial" => "729"
                        "paginaFinal" => "736"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16965422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The psychosocial and occupational impact of chronic skin disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Hong"
                            1 => "B&#46; Koo"
                            2 => "J&#46; Koo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1529-8019.2008.00170.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Dermatol Ther"
                        "fecha" => "2008"
                        "volumen" => "21"
                        "paginaInicial" => "54"
                        "paginaFinal" => "59"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18318886"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1552526011000999"
                          "estado" => "S300"
                          "issn" => "15525260"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Depression in dermatological patients identified by the Mini International Neuropsychiatric Interview questionnaire"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;D&#46; Cohen"
                            1 => "A&#46; Ofek-Shlomai"
                            2 => "D&#46;A&#46; Vardy"
                            3 => "Z&#46; Weiner"
                            4 => "P&#46; Shvartzman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2005.09.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2006"
                        "volumen" => "54"
                        "paginaInicial" => "94"
                        "paginaFinal" => "99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16384762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Work limitations and productivity loss are associated with health-related quality of life but not with clinical severity in patients with psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Schmitt"
                            1 => "D&#46;E&#46; Ford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000093848"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatology"
                        "fecha" => "2006"
                        "volumen" => "213"
                        "paginaInicial" => "102"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16902286"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:1 [
                  "referenciaCompleta" => "Finnish Medical Society Duodecim&#46; Psoriasis&#46; In&#58; EBM Guidelines&#46; Evidence-Based Medicine &#91;Internet&#93;&#46; Helsinki Finland&#58; Wiley Interscience&#46; John Wiley &#38; Sons&#59; 2005&#46;"
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              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life and treatment satisfaction among patients with psoriasis and psoriatic arthritis and patients with psoriasis only&#58; results of the 2005 Spring US National Psoriasis Foundation Survey"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;H&#46; Ciocon"
                            1 => "E&#46;J&#46; Horn"
                            2 => "A&#46;B&#46; Kimball"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "111"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18284265"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient satisfaction with psoriasis therapies&#58; an update and introduction to biologic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;Y&#46; Finlay"
                            1 => "J&#46;P&#46; Ortonne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10227-005-0030-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Cutan Med Surg"
                        "fecha" => "2004"
                        "volumen" => "8"
                        "paginaInicial" => "310"
                        "paginaFinal" => "320"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15868312"
                            "web" => "Medline"
                          ]
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                          "pii" => "S1552526010000786"
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                          "issn" => "15525260"
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                  ]
                ]
              ]
            ]
            29 => array:3 [
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              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current management of psoriasis in the United Kingdom&#58; patterns of prescribing and resource use in primary care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;E&#46; Gillard"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1368-5031.2005.00680.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2005"
                        "volumen" => "59"
                        "paginaInicial" => "1260"
                        "paginaFinal" => "1267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236077"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis treatment in the United States at the end of the 20th century"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;J&#46; Pearce"
                            1 => "K&#46;H&#46; Stealey"
                            2 => "R&#46; Balkrishnan"
                            3 => "A&#46;B&#46; Fleischer"
                            4 => "S&#46;R&#46; Feldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2006.02532.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2006"
                        "volumen" => "45"
                        "paginaInicial" => "370"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16650160"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Members of the national psoriasis foundation&#58; more extensive disease and better informed about treatment options"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Nijsten"
                            1 => "T&#46; Rolstad"
                            2 => "S&#46;R&#46; Feldman"
                            3 => "R&#46;S&#46; Stern"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1001/archderm.141.1.19"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2005"
                        "volumen" => "141"
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                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15655138"
                            "web" => "Medline"
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Vol. 102. Núm. 4.
Páginas 270-276 (mayo 2011)
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Vol. 102. Núm. 4.
Páginas 270-276 (mayo 2011)
Original article
Acceso a texto completo
Physician and Patient Perception of Disease Severity, Quality of Life, and Treatment Satisfaction in Psoriasis: An Observational Study in Spain
Percepción del médico y paciente de la gravedad de la psoriasis, su impacto en la calidad de vida y satisfacción con la atención y el tratamiento recibido.Estudio observacional en España
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E. Daudéna,
Autor para correspondencia
estebandauden@medynet.com

Corresponding author.
, J. Conejob, C. García-Calvoc
a Sección de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain
b Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Departamento Médico, Pfizer, S.L., Spain
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Abstract
Objectives

The aims of this study were to determine the impact of psoriasis on patient quality of life, to analyze differences in perception between patients and physicians regarding quality of life, treatment satisfaction, and patient needs, and to assess the physician-patient relationship.

Material and methods

A multicenter, observational, cross-sectional study was undertaken in which a representative group of dermatologists–working in hospitals and outpatient clinics throughout Spain–and their patients with a diagnosis of psoriasis completed specifically designed questionnaires. The questionnaires covered patient demographics, disease characteristics, impact of the disease on quality of life, treatment of psoriasis, and the relationship between patient and dermatologist.

Results

A total of 151 dermatologists from throughout Spain included a mean of 5 patients each. The analysis included 771 questionnaires completed by dermatologists and 732 completed by patients. Two-thirds of patients had moderate-to-severe psoriasis with a major impact on quality of life, particularly in relation to emotional wellbeing. Nevertheless, quality of life was only assessed routinely and systematically by 19.9% of dermatologists. Overall, 47% of patients reported being quite satisfied or very satisfied with the treatment they received. No significant differences were observed between patients and dermatologists on the aspects analyzed.

Conclusions

Our results highlight the substantial impact of psoriasis on patient quality of life and the consequent need for systematic quality-of-life assessment in affected patients. Patients reported a high level of satisfaction with the care provided by dermatologists and the treatment received. There was good agreement between patients and dermatologists in their assessment of the variables analyzed.

Keywords:
Psoriasis
Quality of life
Physician-patient relationship
Treatment satisfaction
Resumen
Introducción

El objetivo de este estudio fue evaluar el impacto de la psoriasis en la calidad de vida del paciente, las diferencias entre médicos y pacientes en las percepciones sobre la calidad de vida, los tratamientos y las necesidades de los pacientes y la relación médico-paciente.

Material and métodos

Estudio observacional, multicéntrico, de corte transversal, en el cual un grupo de dermatólogos representativos de toda la geografía española, con ejercicio tanto en el ámbito hospitalario como ambulatorio, y de pacientes con diagnóstico de psoriasis, cumplimentaron una encuesta especialmente diseñada para el estudio. La encuesta incluía preguntas sobre datos demográficos del paciente, características de la enfermedad, impacto de esta sobre la calidad de vida, manejo terapéutico de la psoriasis y relación paciente-dermatólogo.

Resultados

Un total de 151 dermatólogos de toda España incluyeron una media de 5 pacientes cada uno. Se incluyeron en el análisis un total de 771 encuestas cumplimentadas por los dermatólogos y 732 encuestas cumplimentadas por los pacientes. Dos terceras partes de los pacientes presentaban una enfermedad moderada a grave con una importante repercusión en la calidad de vida, en especial sobre el estado emocional. No obstante, la calidad de vida sólo era evaluada de forma sistemática y rutinaria por el 19,9% de los dermatólogos. El 47% de los pacientes estaba muy satisfecho o bastante satisfecho con el tratamiento que recibía. No se encontraron diferencias relevantes entre las percepciones del paciente y del médico sobre los aspectos evaluados.

Conclusiones

Nuestros resultados señalan el importante impacto que tiene la psoriasis sobre la calidad de vida del paciente y la necesidad de evaluar este parámetro de forma sistemática. Los pacientes refieren un buen grado de satisfacción con la atención recibida por los dermatólogos y los tratamientos administrados. Existe bastante concordancia entre los pacientes y los dermatólogos en la valoración de los parámetros evaluados.

Palabras clave:
Psoriasis
Calidad de vida
Relación médico paciente
Satisfacción
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References
[1.]
S.P. Raychaudhuri, E.M. Farber.
The prevalence of psoriasis in the world.
J Eur Acad Dermatol Venereol, 15 (2001), pp. 16-17
[2.]
C. Ferrándiz, X. Bordas, V. García-Patos, S. Puig, R. Pujol, A. Smandía.
Prevalence of psoriasis in Spain (Epiderma Project: phase I).
J Eur Acad Dermatol Venereol, 15 (2001), pp. 20-23
[3.]
D.G. Fortune, H.L. Richards, C.E. Griffiths.
Psychologic factors in psoriasis: consequences, mechanisms, and interventions.
Dermatol Clin, 23 (2005), pp. 681-694
[4.]
C. Ferrándiz Foraster, A. García-Díez, L. Lizán Tudela, L. Bermúdez-Rey, X. Badia Llach.
Impact of psoriasis on health-related quality of life.
Med Clin (Barc), 128 (2007), pp. 325-329
[5.]
H.L. Richards, D.G. Fortune, C.E. Griffiths, C.J. Main.
The contribution of perceptions of stigmatisation to disability in patients with psoriasis.
J Psychosom Res, 50 (2001), pp. 11-15
[6.]
M.A. Gupta, A.K. Gupta.
Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis.
Br J Dermatol, 139 (1998), pp. 846-850
[7.]
A. Picardi, E. Mazzotti, P. Pasquini.
Prevalence and correlates of suicidal ideation among patients with skin disease.
J Am Acad Dermatol, 54 (2006), pp. 420-426
[8.]
K. Poikolainen, J. Karvonen, E. Pukkala.
Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis.
Arch Dermatol, 135 (1999), pp. 1490-1493
[9.]
M. Lebwhol, J.P. Callen.
Obesity, smoking, and psoriasis.
JAMA, 295 (2006), pp. 208-210
[10.]
L. Mallbris, O. Akre, F. Granath, L. Yin, B. Lindelöf, A. Ekbom, et al.
Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients.
Eur J Epidemiol, 19 (2004), pp. 225-230
[11.]
D.G. Fortune, H.L. Richards, B. Kirby, K. McElhone, T. Markham, S. Rogers, et al.
Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy.
Arch Dermatol, 139 (2003), pp. 752-756
[12.]
H.S. Javitz, M.M. Ward, E. Farber, L. Nail, S.G. Vallow.
The direct cost of care for psoriasis and psoriatic arthritis in the United States.
J Am Acad Dermatol, 46 (2002), pp. 850-860
[13.]
D.J. Pearce, S. Singh, R. Balkrishnan, A. Kulkarni, A.B. Fleischer, S.R. Feldman.
The negative impact of psoriasis on the workplace.
J Dermatolog Treat, 17 (2006), pp. 24-28
[14.]
J. de Korte, M.A. Sprangers, F.M. Mombers, J.D. Bos.
Quality of life in patients with psoriasis: a systematic literature review.
J Investig Dermatol Symp Proc, 9 (2004), pp. 140-147
[15.]
A.Y. Finlay, S.E. Kelly.
Psoriasis--an index of disability.
Clin Exp Dermatol, 12 (1987), pp. 8-11
[16.]
A.Y. Finlay, E.C. Coles.
The effect of severe psoriasis on the quality of life of 369 patients.
Br J Dermatol, 132 (1995), pp. 236-244
[17.]
S.R. Rapp, S.R. Feldman, M.L. Exum, A.B. Fleischer, D.M. Reboussin.
Psoriasis causes as much disability as other major medical diseases.
J Am Acad Dermatol, 41 (1999), pp. 401-407
[18.]
Nacional Psoriasis Foundation. Spring 2007 Survey Panel Snapshot. Available from: http://psoriasis.org/files/pdfs/research/2007_spring_survey_panel.pdf.(last accessed January 14, 2008).
[19.]
R.S. Stern, T. Nijsten, S.R. Feldman, D.J. Margolis, T. Rolstad.
Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction.
J Investig Dermatol Symp Proc, 9 (2004), pp. 136-139
[20.]
A.M. Eghlileb, E.E. Davies, A.Y. Finlay.
Psoriasis has a major secondary impact on the lives of family members and partners.
Br J Dermatol, 156 (2007), pp. 1245-1250
[21.]
M. Sánchez-Regaña, R. Ojeda-Cuchillero, I. Umbert-Millet, P. Umbert-Millet, W. Lupo, J. Solé-Fernández.
El impacto psicosocial de la psoriasis.
Actas Dermosifiliogr, 94 (2003), pp. 11-16
[22.]
M. Ribera, G. Caballé, N. Fernández-Chico, M.J. Fuente, C. Ferrándiz.
Impacto de la psoriasis en la calidad de vida del paciente español.
Piel, 19 (2004), pp. 242-249
[23.]
L. Dubertret, U. Mrowietz, A. Ranki, P.C. van de Kerkhof, S. Chimenti, T. Lotti, et al.
European patient perspectives on the impact of psoriasis: the EUROPSO patient membership survey.
Br J Dermatol, 155 (2006), pp. 729-736
[24.]
J. Hong, B. Koo, J. Koo.
The psychosocial and occupational impact of chronic skin disease.
Dermatol Ther, 21 (2008), pp. 54-59
[25.]
A.D. Cohen, A. Ofek-Shlomai, D.A. Vardy, Z. Weiner, P. Shvartzman.
Depression in dermatological patients identified by the Mini International Neuropsychiatric Interview questionnaire.
J Am Acad Dermatol, 54 (2006), pp. 94-99
[26.]
J.M. Schmitt, D.E. Ford.
Work limitations and productivity loss are associated with health-related quality of life but not with clinical severity in patients with psoriasis.
Dermatology, 213 (2006), pp. 102-110
[27.]
Finnish Medical Society Duodecim. Psoriasis. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki Finland: Wiley Interscience. John Wiley & Sons; 2005.
[28.]
D.H. Ciocon, E.J. Horn, A.B. Kimball.
Quality of life and treatment satisfaction among patients with psoriasis and psoriatic arthritis and patients with psoriasis only: results of the 2005 Spring US National Psoriasis Foundation Survey.
Am J Clin Dermatol, 9 (2008), pp. 111-117
[29.]
A.Y. Finlay, J.P. Ortonne.
Patient satisfaction with psoriasis therapies: an update and introduction to biologic therapy.
J Cutan Med Surg, 8 (2004), pp. 310-320
[30.]
S.E. Gillard, A.Y. Finlay.
Current management of psoriasis in the United Kingdom: patterns of prescribing and resource use in primary care.
Int J Clin Pract, 59 (2005), pp. 1260-1267
[31.]
D.J. Pearce, K.H. Stealey, R. Balkrishnan, A.B. Fleischer, S.R. Feldman.
Psoriasis treatment in the United States at the end of the 20th century.
Int J Dermatol, 45 (2006), pp. 370-374
[32.]
T. Nijsten, T. Rolstad, S.R. Feldman, R.S. Stern.
Members of the national psoriasis foundation: more extensive disease and better informed about treatment options.
Arch Dermatol, 141 (2005), pp. 19-26
Copyright © 2011. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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