VANCOUVER – Touch impairment is an important but largely unappreciated aspect of quality-of-life impairment in psoriasis, Dr. April Armstrong said at the World Congress of Dermatology.
“Touch avoidance is a new concept in dermatology, and I think it’s great because it really brings home a humanistic aspect to research,” observed Dr. Armstrong, director of the psoriasis program at the University of Colorado, Denver.
Dr. April Armstrong
“Touch is a fundamental human gesture that conveys understanding, connection, validation, as well as being cared for or caring for someone,” she added.
She presented an online study of 1,109 psoriasis patients, 70% of whom were female. When asked whether within the past 2 weeks they had avoided hugging, shaking hands, or other touching of others, or of being touched, because of how their skin looks or feels, 48% responded yes. On a 0-10 scale, 27% of the overall patient population rated themselves as having touch avoidance at the level of 4-10, corresponding to moderate to severe.
In a multivariate analysis, the prevalence or severity of touch avoidance didn’t vary by gender. However, touch avoidance was reported most often by patients under age 25 years. And touch avoidance was strongly associated with disease severity: Those with mild psoriasis as defined by body surface area of involvement were only about one-third as likely to report touch avoidance, compared with those with severe disease. Also, psoriatic itching was an important correlate of touch avoidance: Those with itch were roughly fivefold more likely to report recent touch avoidance.
In addition, patients with psoriasis on exposed areas such as the face and neck or in sensitive areas such as the genitalia were more likely to report touch avoidance.
Touch avoidance had a strong negative impact on quality of life. Scores on the Dermatology Life Quality Index averaged nearly threefold higher – indicating worse quality of life – in participants who reported touch avoidance. They were at similarly increased risk for mild or greater depressive symptoms based upon their scores on the Quick Inventory of Depressive Symptoms.
Thus, touch avoidance is an important new patient-reported outcome, and these study results open up a new area of psoriasis research, according to Dr. Armstrong.
“Future research may reveal that therapies offering clearance of psoriasis, particularly in sensitive areas, could lead to large improvements in the initiation and acceptance of interpersonal touch by patients with psoriasis,” she noted.
This study was supported by the National Psoriasis Foundation. Dr. Armstrong reported receiving research grants from and/or serving as a consultant to more than half a dozen pharmaceutical companies as well as the National Institutes of Health.