Among children aged 5–16, psoriasis decreased health-related quality of life (HRQL) by 30.5% (
p < 0.001)
[13]. Psoriasis affected HRQL more than epilepsy, enuresis, and diabetes. In a similar study of 118 children aged 5–16 years surveyed with the CDLQI, psoriasis and atopic dermatitis had a greater impact on HRQL compared to other chronic dermatologic conditions, such as vitiligo
[13]. In a qualitative study of 32 adolescent dermatology patients ages 12–19 years, those with psoriasis were affected by the greatest range of different HRQL domains, including psychological, social, and physical
[14]. The psychological domain specifically focused on emotional aspects, bullying, self-esteem, and judgement from others
[14]. Children with psoriasis reported the greatest impairment of quality of life based on scoring from the CDLQI, followed by those with atopic dermatitis
[15]. The CDLQI scores for pediatric psoriasis patients ranked higher than those for alopecia, localized eczema, acne, and urticaria patients
[15].
Psoriasis may impact the lives of both the patients and their caregivers. In a multicenter study of 129 pediatric patients with psoriasis and their caregivers, the CDLQI and DFI were used to evaluate the effect of psoriasis on the quality of life of the children and their family members
[16]. The average CDLQI score was 7.6, suggesting a moderate effect on the quality of life of the patients, with personal feelings being the most severely impacted domain
[16]. Emotions were the most severely impaired domain for caregivers based on the DFI. The DFI score was positively correlated with the CDLQI score (r = 0.554,
p < 0.001) and the PASI (r = 0.350,
p < 0.001)
[16]. Among patients with more rigorous treatment regimens, including systemic agents and phototherapy, there was impairment in multiple domains for the quality of life of their caregivers compared to those receiving first-line therapies
[16]. Caretakers of pediatric patients with psoriasis experience psychological strain due to the unpredictable pattern of their child’s disease, leading to feelings of helplessness
[17]. They often report frustration over dealing with their child’s low mood and dissatisfaction over medical care
[17]. Some caregivers felt overwhelmed by the responsibility of caring for their child’s condition and described compromising their own personal health for the sake of their family
[17].
Adolescent patients with psoriasis frequently face challenges regarding poor self-esteem, difficulties with sexual intimacy, stigmatization, and strained family and social relationships
[13]. Psoriasis especially impacts the types of physical activities adolescents engage in, particularly extracurricular sports, which may negatively contribute to other comorbidities associated with psoriasis, including diabetes, obesity, hypertension, and psychiatric disorders
[13]. The visible nature of this skin condition and its associated discomfort both contribute to the avoidance of physical activity in this age group
[13]. In an online focus group, 48% of adolescent participants cited the visibility as the “worst” aspect of psoriasis as well as the loss of control since psoriatic lesions are often recurrent and unpredictable
[13]. These negative thoughts about their bodies may affect the self-esteem of adolescents over time and put them at a higher risk of psychiatric conditions such as depression and anxiety. Compared to healthy controls, self-esteem (SE) (
p < 0.001) and body image (BI) (
p = 0.021) were lower in patients with psoriasis
[18]. Psoriasis Area and Severity Index (PASI) was negatively correlated with BI (r = −0.423) but positively correlated with the quality of life (
r = 0.703) and SE (
r = 0.448). Another study demonstrated that poor SE in patients with psoriasis was highly associated with comorbid psychopathologies, such as sexual dysfunction disorders, anxiety, depression, and suicidality. Educational status did not affect DLQI scores in psoriasis patients; however, SE improved with higher education levels (
p < 0.05)
[18].
Psoriasis especially affects appearance, confidence, and lifestyle in adolescent patients. Adolescent patients report feelings of loss of control because of the unpredictable course their disease, which impedes their ability to cope
[15]. They agree that self-esteem issues stemming from psoriasis stay with them in the long term, sometimes after complete clearance
[15]. Some of the most common coping mechanisms are avoidance behaviors or concealing strategies, which may affect their daily activities or intimacy with sexual partners. Talking with peers helps some adolescents with their confidence, feelings of loneliness, and their knowledge of other coping mechanisms
[15]. The main contributors to depression among patients with psoriasis were female gender, poor perception of their appearance, poor self-worth, increased psychological distress, and reduced emotional social support
[19]. Therefore, achieving better/complete clearance through proper treatment may positively affect their body image and may prevent the development of other psychiatric conditions such as depression
[19].