Background: The Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) are important evaluation tools for assessing psoriasis severity and guiding treatment options. However, the scores of PASI and DLQI are often inconsistent. Objective: This study aimed to identify the factors affecting the consistency between PASI and DLQI. Methods: The retrospective study was based on 4125 patients. We collected the PASI, DLQI, demographic and clinical characteristics data. Results: DLQI has a weak correlation with PASI (r=0.37; P< 0.001). For the DLQI > 10 groups, DLQI has almost no correlation with PASI (r=0.16; P< 0.001). There are 43.60% of mild-to-moderate patients (PASI< 10) in the DLQI> 10 groups. Our adjusted model showed that foot (OR=2.109; 95% CI:1.581– 2.815) involvement led to the greatest impairment of QoL except for PASI≥ 10 (OR=5.547; 95% CI:3.477– 8.845). Furthermore, DLQI impairment was associated with female (OR=1.336; 95% CI:1.071– 1.667); the age of 20– 39 subgroup (OR=1.795; 95% CI:1.100– 2.930); psoriatic arthritis (OR=1.718; 95% CI:1.208– 2.443); higher income (OR = 1.408; 95% CI: 1.067– 1.858); family history of psoriasis (OR=1.460; 95% CI:1.131– 1.885). Moreover, the influence of exposed lesions (such as scalp; face; neck; nails; and hands) were positively associated with severely impaired QoL. Conclusion: Dermatologists should recognize the underestimated disease burden of psoriasis patients and actively identify and treat mild-to-moderate patients with high burden. In particular, the foot was a significant contributor to the burden.

Purpose: Psoriasis patients often suffers from anxiety and depression. Inflammation, anxiety, and depression have been associated with each other, but the relationship has not been examined in subjects with psoriasis. The primary objective was to investigate the relationship between the C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) and depression among patients with psoriasis. Methods: In this case-control, cross-sectional study, 239 individuals with psoriasis and 142 with healthy controls (HCs) were recruited. Psychological as well as clinical, and laboratory data were collected. Results: 50.2% of subjects with psoriasis reported depressive symptoms, compared with 26.8% of HCs. 39.7% and 17.6% observed anxiety symptoms in psoriasis patients and HCs. The odds of anxiety (AOR= 3.123; 95% CI = 1.851– 5.269) and depression (AOR= 2.698; 95% CI = 1.690– 4.306) were higher in psoriasis patients relative to HCs. Furthermore, the elevated CRP (AOR =2.139; 95% CI = 1.249– 3.663) and ESR (AOR =1.827; 95% CI = 1.078– 3.096) were the risk factors of depression in patients with psoriasis. The threshold for distinguish psoriasis patients in depression was 3.24 (area under the curve [AUC], 0.605; sensitivity, 0.57; specificity, 0.64) for CRP and 26.5 (AUC, 0.632; sensitivity, 0.52; specificity, 0.73) for ESR. Conclusion: A substantial prevalence of anxiety and depression symptoms was observed in Chinese psoriasis subjects, and the odds were much higher in psoriasis patients relative to HCs. The elevated CRP and ESR level was significantly associated with depression in psoriasis patients. Besides, the discrimination capability of CPR and ESR on depression further indicates the extra value of inflammatory biomarkers in the management of psoriasis patients.