Xin Ma,1,2,* Quanruo Xu,3,* Le Kuai,4,* Fanlingzi Shen,3 Zhen Duan,3 Xiangjin Gao,1 Rui Zhang,1 Ruiping Wang1,3 

1Clinical Research Center, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Department of Traditional Chinese Medicine, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 4Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ruiping Wang, Clinical Research Center, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, 1278 Baode Road, Jing’an District, Shanghai, 200443, People’s Republic of China, Email w19830901@126.com

Introduction: Psoriasis is a chronic immune-mediated disease that significantly impacts patients clinically and psychologically. Physician-assessed severity measures, including Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Physician Global Assessment (PGA), often fail to capture patient-reported outcomes, particularly when clinical improvement and perceived quality-of-life gains are misaligned.
Purpose: To clarify the association between clinical improvements and Dermatology Life Quality Index (DLQI) outcomes, identify predictors of substantial DLQI improvement (≥ 90% reduction), and explore reasons for suboptimal DLQI responses in patients achieving skin clearance.
Methods: In this 12-week prospective study, 551 psoriasis patients were enrolled at Shanghai Skin Diseases Hospital. Data on demographics, clinical severity (PASI, BSA, and PGA), DLQI scores, and treatment modalities were collected. Logistic regression analyses were employed to assess the dose–response relationships between improvements in clinical parameters and DLQI reduction, and to identify factors of suboptimal DLQI improvement among patients achieving significant skin clearance.
Results: Median DLQI improved significantly (8.0 to 3.0) at week 12, with 24.1% of patients achieving ≥ 90% DLQI reduction. Strong dose-response associations existed between clinical severity improvements (PASI, BSA, PGA) and DLQI gains. PASI75 responders were significantly more likely to achieve substantial DLQI improvement (OR = 2.48, 95% CI: 1.51– 4.07). However, only 33.3% of PASI75 achievers reached ≥ 90% DLQI improvement. Early clinical response (as early as week 4) strongly predicted superior DLQI outcomes. Female sex, older age, lower baseline DLQI scores, and shorter disease duration were associated with achieving high skin clearance but suboptimal DLQI improvement.
Conclusion: Early clinical response effectively predicts substantial DLQI improvement, whereas demographic and disease-related factors help identify patients at risk for suboptimal quality-of-life gains despite significant skin clearance. These insights support personalized therapeutic strategies aimed at improving patient satisfaction beyond skin clearance alone.

Keywords: psoriasis, quality of life, biologic agents, cohort study