From skin clearance to psychological wellbeing: real-world outcomes of biologic therapy in psoriasis.

BACKGROUND

Psoriasis impacts psychological and quality-of-life (QoL). While biologic therapies demonstrated robust efficacy in reducing skin lesions, their broader psychosocial impact remains underexplored in real-world settings. This ambispective observational cohort study evaluated clinical, psychological, and health-related QoL (HRQoL) outcomes of biologic therapy in patients with moderate-to-severe plaque psoriasis treated in routine dermatological practice.

METHODS

A total of 133 patients undergoing biologic therapy at a referral center in Northern Italy were assessed. Baseline data (T0) were retrospectively extracted from medical records, while 6-month follow-up assessments (T1) were conducted prospectively. Clinical severity (PASI), depression (PHQ-9, BSI-18), anxiety and somatization (BSI-18), perceived stress (PSS), dermatology-specific QoL (DLQI), and general HRQoL (WHOQOL-BREF) were evaluated. Regression models identified baseline predictors of T1 psychological and QoL outcomes.

RESULTS

At follow-up, patients reported significant improvements in psychological wellbeing and QoL. PHQ-9 scores decreased markedly (p < 0.001), with the prevalence of moderate-to-severe depressive symptoms dropping from 28.6% to 5.3%. Substantial perceived stress (PSS ≥ 27) declined from 15.0% to 1.5%. DLQI scores showed a large effect size (p < 0.001), with 89.5% reporting minimal impact (DLQI 0-1) at follow-up. Regression analyses identified baseline psychological symptoms as the strongest predictors of follow-up psychological and QoL outcomes. Additional predictors included PASI, female sex, psychiatric comorbidity, and previous biologic therapy. At T1, 77.4% achieved complete skin clearance (PASI 100).

CONCLUSION

Biologic therapies confer multidimensional benefits in moderate-to-severe psoriasis, extending beyond skin clearance to substantial reductions in psychological distress and improvements in QoL. These findings support a patient-centered model integrating dermatologic and mental health care.