Quality of life impairment beyond skin severity in patients with psoriasis: A narrative review

Background: Psoriasis is a chronic immune-mediated inflammatory skin disease that affects patients beyond visible skin lesions. Although clinical severity is commonly assessed using the Psoriasis Area and Severity Index (PASI), the daily burden experienced by patients is more broadly reflected by patient-reported measures such as the Dermatology Life Quality Index (DLQI). This review discusses quality-of-life impairment in patients with psoriasis beyond skin severity alone.
Methods: A narrative review was conducted using literature from PubMed, Google Scholar, Scopus, and ScienceDirect. Relevant articles addressing psoriasis, quality of life, DLQI, PASI, symptom burden, psychosocial burden, treatment burden, adherence, and patient-reported outcomes were included.
Results: Psoriasis may impair quality of life through persistent symptoms, sleep disturbance, embarrassment, stigma, emotional distress, social limitation, occupational difficulties, and treatment-related burden. PASI is useful for measuring erythema, induration, scaling, and body surface area involvement, but it does not directly capture how the disease affects sleep, confidence, relationships, daily activities, or treatment experience. DLQI provides a complementary view by assessing the patient’s perception of disease impact. Therefore, clinical severity and patient-perceived burden may be related but not always proportional.
Conclusion: Quality-of-life assessment should be integrated into routine psoriasis management alongside clinical severity scoring. A patient-centered approach that considers both objective disease activity and subjective burden may improve treatment planning, adherence, satisfaction, and long-term care outcomes.