German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Eur Acad Dermatol Venereol. 2021 Nov;35(11):2166-2184. doi: 10.1111/jdv.17348. Epub 2021 Jun 25.
Patients with chronic skin diseases suffer from physical and psychosocial impairments which can lead to a cumulative life-long burden. Therefore, the concept of cumulative life course impairment (CLCI) was introduced, referring to the non-reversible damage due to the persistent life-long burden. This systematic review (PROSPERO registry number: CRD42020179141) aimed at mapping the risk factors and the associated burden over time in patients with psoriasis, atopic dermatitis (AD) and hidradenitis suppurativa (HS). Three electronic databases were searched (date of the last search: December 2019). Studies with a longitudinal study design that assessed the association between a risk factor and the associated burden over time in patients with psoriasis, AD and HS were included. Quality assessment of the included studies was done using Critical Appraisal Skills Programme (CASP) checklists. In total, 40 publications reflecting 25 different studies were included: nine studies addressed patients with psoriasis, 13 patients with AD, two studies included patients with HS and one study enrolled patients with psoriasis and AD, respectively. Twenty-two potential risk factors with underlying evidence were found in this review. These risk factors include mainly sociodemographic (such as age or gender) and clinical (such as disease severity or comorbidities) variables. Disease severity and comorbidities were the most often studied risk factors, while only a few studies evaluated psychosocial risk factors over time. Patients with chronic skin diseases are at high risk to develop a life-long negative impact from the disease. However, there is a lack of data that evaluates the psychosocial burden and its influence on the patients' life course over time. The risk factors found in this review help to identify patients at risk, to treat them adequately and, ultimately, to prevent CLCI. These results can be the basis to develop a highly needed tool to assess the risk for CLCI in the future.
患有慢性皮肤病的患者会受到身体和心理社会方面的损伤，这些损伤可能会导致终身的累积负担。因此，引入了累积生命过程损伤（CLCI）的概念，指的是由于持续的终身负担而造成的不可逆转的损伤。本系统评价（PROSPERO 注册号：CRD42020179141）旨在绘制银屑病、特应性皮炎（AD）和化脓性汗腺炎（HS）患者的风险因素及其随时间推移的相关负担。共检索了三个电子数据库（最后检索日期：2019 年 12 月）。本研究纳入了采用纵向研究设计、评估患者银屑病、AD 和 HS 中风险因素与相关负担随时间变化的关联的研究。采用批判性评估技巧方案（CASP）检查表对纳入研究进行质量评估。共纳入 40 篇文献，反映了 25 项不同的研究：9 项研究涉及银屑病患者，13 项研究涉及 AD 患者，2 项研究包括 HS 患者，1 项研究分别纳入了银屑病和 AD 患者。本综述发现了 22 个具有潜在证据的潜在风险因素。这些风险因素主要包括社会人口统计学（如年龄或性别）和临床（如疾病严重程度或合并症）变量。疾病严重程度和合并症是研究最多的风险因素，而只有少数研究随时间评估了心理社会风险因素。患有慢性皮肤病的患者有很高的风险会因疾病而产生终身的负面影响。然而，目前缺乏评估心理社会负担及其对患者生活轨迹随时间推移的影响的数据。本综述中发现的风险因素有助于识别处于风险中的患者，对其进行充分治疗，并最终预防 CLCI。这些结果可以为未来开发评估 CLCI 风险的高度需要的工具提供基础。
