|Year : 2020 | Volume
| Issue : 2 | Page : 102-108
Perception and assessment of psoriasis in the general population of Riyadh, Saudi Arabia
Seba Almutairi1, Abdulaziz Alotaibi1, Mohammad A Almohideb2
1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Division of Dermatology, Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
|Date of Submission||27-Oct-2019|
|Date of Decision||27-Jun-2020|
|Date of Acceptance||22-Jul-2020|
|Date of Web Publication||19-Aug-2020|
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh
Source of Support: None, Conflict of Interest: None
Context: Psoriasis is a chronic skin condition with a prevalence ranging from 0.51% to 11.43% and 0% to 1.37% among adults and children, respectively. Its consequences can affect patients' quality of life. Aims: This study aims to assess the perception of psoriasis among general population at Riyadh, Saudi Arabia. Subjects and Methods: This is a cross-sectional study based on a structured interview questionnaire that was distributed among the residents of Riyadh. Inclusion criteria encompassed participants ≥18 years old, all educational levels, nationalities, and both genders living at Riyadh. The minimum sample size required was 385. The data were analyzed using SPSS version 23 with confidence interval of 95% and P ≤ 0.05 considered statistically significant. Results: This study included 101 (26.2%) men and 284 (73.8%) women. Seventy-eight percent of the participants were familiar with the term “psoriasis”' in Arabic. The majority of the participants had heard about the term from family and friends. Sixty-eight percent of the participants considered the disease to place a significant burden on affected individuals, 41% stated that there are effective drugs available for the treatment of psoriasis, and 12.2% considered the disease to be contagious. Some of participants did not want to shake hands, share their food, share the same swimming pool, and be in a relationship with psoriatic patients (18.2%, 13%, 54.1%, and 32%, respectively). Conclusions: Although most of Saudi population are familiar with the term “psoriasis” in Arabic, there is a significant lack of knowledge about psoriasis. This emphasizes on the need to increase psoriasis awareness, which may be achieved through campaigns, seminars, and the media to improve the knowledge and reduce the stigmatization of psoriasis.
Keywords: Dermatology, perception, psoriasis, stigmatization
|How to cite this article:|
Almutairi S, Alotaibi A, Almohideb MA. Perception and assessment of psoriasis in the general population of Riyadh, Saudi Arabia. Saudi J Health Sci 2020;9:102-8
| Introduction|| |
Psoriasis is a chronic noninfectious skin condition that is characterized by inflammation, erythema, and scaly patches on the skin, but it may also affect other parts of the body, including joints and nails. There are a number of varieties of psoriasis, including plaque psoriasis, inverse (flexural) psoriasis, pustular psoriasis, and guttate psoriasis. A systematic review estimated the prevalence of psoriasis to be between 0.51% and 11.43% and 0% and 1.37% in adults and children, respectively. The prevalence of psoriasis in Saudi Arabia's Eastern Province has been estimated to be 5.3%, and 53% of psoriasis patients develop the condition before the age of 30 years. Another study estimated the prevalence of psoriasis in Saudi Arabia's Capital Region, Riyadh, to be 2.47%. Although the exact cause of psoriasis remains unclear, there are multifactorial aspects to its etiology and pathogenesis, including immunologic, genetic, and environmental factors.
Psoriasis can affect an individual's quality of life in many ways, including through effects on employment, relationships, leisure activities, social life, self-esteem, and body image., In addition, psoriatic patients might be stigmatized, adding a psychological impact that is reflected in a greater risk of depression, augmented by a lack of social support, which might at least partially be linked to poor psoriasis awareness in the community.
Several studies have demonstrated a significant lack of knowledge and poor attitudes toward psoriasis patients in the general population. In Germany for instance, only 29% of people were found to be familiar with the word “psoriasis,” 10% reported that the disease was communicable and they would not live in the same household as the affected person, 23% did not want to swim in the same pool as an affected person, and 27% did not want to have a relationship with a psoriasis patient. Another study conducted among nonmedical students at Qassim University in Saudi Arabia found that 27% had no information about the disease, ~46% did not know the nature of the disease, 21% thought that the disease was untreatable, 70% of parents would not approve their daughter's marriage to a psoriasis patient, and ~63% would not accept food made by a psoriasis patient.
Few previous studies have attempted to characterize the general population's understanding of psoriasis. Therefore, we aimed to assess the perception of psoriasis in the general population of the capital and most populous city of Saudi Arabia, Riyadh, intending to make recommendations about disease awareness on the basis of the results of the study.
| Subjects and Methods|| |
A cross-sectional study was conducted using a structured interview questionnaire that was completed by a sample of 385 residents of Riyadh city. The study was carried out from July 2018 to March 2019. The participants were of all levels of education, Arabic speaking (Saudi or non-Saudi), both sexes, ≥18 years of age, and living in Riyadh. We excluded nonresidents of Riyadh, people with mental impairments, and those <18 years of age. All the participants were approached using a nonprobability convenience sampling technique until the appropriate sample size was obtained. The required sample size was calculated using the Raosoft sample size calculator (http://www.raosoft.com/samplesize.html), assuming a population size of 8,000,000, a 5% margin of error, 95% confidence interval, and 50% as the response distribution. The calculated minimum required sample size was 385.
The questionnaire was designed to collect demographic data regarding the participants' age, sex, nationality, and educational level. The questions used to assess psoriasis perception included questions designed to evaluate disease familiarity, personal experience, awareness, sources of information, and beliefs about psoriasis. The questionnaire was adapted from the validated version generated by the National Conference on Health Care in Psoriasis, which involved a panel of experts consisting of dermatologists, psychologists, media researchers, and patients. The questionnaire was initially structured in English language and translated into Arabic language by an expert and then another independent expert translated it back into English language to access the validity of constructs. The questionnaire was validated by three experts in the field of dermatology to assess the content validity. Pilot test was done to assess the reliability of the questionnaire and Cronbach's alpha was found to be >0.7.
After validation, the research team randomly picked participants in public places, such as shopping malls, supermarkets, and coffee shops. The research team interviewed the participants after explaining the study aim and objectives, gaining their acceptance, and obtaining their informed consent to complete the questionnaire. The questionnaire was completed anonymously without any identifiers being used, in order to maintain the participants' privacy throughout the process.
Consent was obtained from all participants. Ethical approval (Memo Ref. No. IRBC/256/R) was obtained from the Institutional Review Board of King Abdullah International Medical Research Center in Riyadh, Saudi Arabia.
The data were analyzed using SPSS version 23 (IBM, Inc., Armonk, NY, USA) after its collection and tabulation. All categorical variables were reported as percentages. The Chi-square test was used to analyze categorical variables, with the significance level set at P < 0.05.
| Results|| |
This study included 385 participants; 101 (26.2%) were men and 284 (73.8%) were women. The age groups included in this study were 18–30 (281; 73%), 31–40 (71; 18.4%), and >40 years old (33; 8.6%). Saudis accounted for 330 (85.7%) of the participants and non-Saudis 55 (14.3%). The majority of the respondents were highly educated, having university degrees, with secondary school graduates being less common, and those with an educational level of lower than secondary school being the least common (72.8%, 24.3%, and 2.9%, respectively). Approximately half of the participants were students (47.7%), 152 (39.5%) of the participants reported that they knew someone with psoriasis, and 7 (1.8%) reported that they themselves were affected by the condition [Table 1].
Familiarity with psoriasis
Most of the participants (302; 78.4%) were familiar with the term “psoriasis” in Arabic. This familiarity was significantly associated with participants who were aged 31–40 years (P = 0.000), non-Saudi (P = 0.038), and female (P = 0.000) [Table 2]. Among those who claimed to be familiar with the disease, most reported that the source of their knowledge was their family, friends, or acquaintances (170; 56.3%), followed by the media (101; 33.4%), dermatologists (24; 8.0%), family physicians (4; 1.3%), and health insurance information (3; 1.0%) [Table 2].
Availability of information about psoriasis
In assessing the participants' awareness about the World Health Organization's (WHO) announcement that psoriasis is considered to be one of five serious noncommunicable diseases, 79% of them reported that they had not heard about it. Saudi participants were less knowledgeable about this (266, P = 0.05), as were male participants (92.1%, P = 0.000). Furthermore, 349 (90.6%) of the respondents stated that they were not familiar with “World Psoriasis Day,” and participants with a higher level of education were significantly less familiar with this (91.6%, P = 0.02) [Table 3].
Participants' beliefs about psoriasis
Most participants (68.6%) agreed that psoriasis places a significant burden on the affected individual. This belief was significantly more likely in women (74.3%, P = 0.000) and among those who were aged >40 years (84.8%, P = 0.018). However, 29.4% of respondents thought that psoriasis placed a significant burden on the affected individual's family and relatives. This belief was significantly more likely among employees (40.9%, P = 0.001) and those who were aged >40 years (63.6%, P = 0.000). In addition, 41% of the participants believed that there were effective drugs available for the treatment of psoriasis. This belief was more likely among women (45.1%, P = 0.013). Twelve percent of the respondents believed that psoriasis was a contagious disease, and there was little variability in the prevalence of this belief with respect to age, sex, nationality, level of education, or employment status [Table 4].
Interaction with psoriasis patients
Fifty-four percent of the participants said that they would not share the same swimming pool with a psoriasis patient, 32% would not get into a personal relationship with an affected individual, 18.2% would not shake hands with an affected person, 13% stated that they would not eat with someone with psoriasis, and 8.3% reported that they did not want to live in the same household as a psoriatic patient. There were no significant differences in these findings with respect to the age, sex, nationality, level of education, or employment status of the participants [Table 5].
Participants' feelings regarding psoriasis
Seventy-nine percent of the participants reported that they felt sorry for psoriasis patients, 64.9% stated that they were disgusted by affected people, and 78.4% thought that patients with psoriasis needed better care for their condition [Table 6].
| Discussion|| |
Our study has shown that 78.4% of the respondents are familiar with the term “psoriasis” in Arabic. This finding is similar to that reported in the German study, which found an awareness level of 80%. However, familiarity with the term did not necessarily imply good knowledge and awareness about the disease. For instance, there were many misconceptions among participants, such as they should avoid shaking hands, sharing food, and sharing the same swimming pool, along with a belief that psoriasis is contagious. In addition, 56.3% of the participants reported their family and friends as the main source of their information about psoriasis, which might lead to the promulgation of misconceptions about the disease. Despite the fact that 39% of the participants knew an affected individual and 1.8% were personally affected, they were not motivated to correct their misconceptions regarding the disease. This may imply that educational campaigns targeting the general population are required.
In the present study, 10.1% of the participants did not think the disease placed a burden on the affected individual. Similarly, 7% of the participants in the German study held the same beliefs. In a review by Kimball et al., it was concluded that a psychological burden resulting from psoriasis could be due to stress, stigmatization, depression, difficulty getting a job, and physical limitation. In a study conducted at Turku University Hospital, it was found that psoriasis places a significant economic burden on affected individuals, in that they must pay for visits, medication, phototherapy sessions, and travel costs. In addition, 39% of participants did not think the disease placed any burden on the relatives of the affected individual, and 37% of the German participants reported the same belief. Eghlileb et al. reported that psoriasis has a huge impact on the quality of life of the affected individual's family and partner. Furthermore, previous studies have identified discriminatory behaviors toward psoriatic patients due either to cultural misconceptions or stigmatization, which prevent patients from enjoying essential social interactions., Similar discriminatory attitudes were also evident in this study, typified by statements that participants would avoid sharing the same swimming pool, getting into a personal relationship, shaking hands, and eating or living in the same household as a psoriasis patient.
Given the prevalence of psoriasis and it's WHO status as one of the five most serious noncommunicable diseases, the results of this study emphasize the necessity of increasing awareness among the general population and providing input to policy makers. Greater awareness can be promoted and achieved through media and social network campaigns, which should positively impact patient outcomes, as demonstrated by the results of several studies regarding awareness programs targeting other diseases.,,,,,
The principal limitations of this study include its cross-sectional study design, which may be associated with recall and information bias. In addition, the study was performed in only one city in Saudi Arabia, limiting the generalizability of the data to other urban and suburban regions of the country. We recommended that a larger nationwide multicenter survey should be conducted to reflect the diversity of the population in Saudi Arabia.
| Conclusion|| |
Although most of the Saudi population are familiar with the term “psoriasis” in Arabic, there is a significant lack of knowledge and understanding of the disease. This emphasizes the need to increase psoriasis awareness, which may be achieved by educating the community through campaigns, seminars, lectures at schools and universities, and through the media and brochures, with the aim of improving knowledge and reducing the stigmatization of psoriasis patients.
We would like to sincerely thank Dr. Rachel Sommer of the Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, for sharing similar surveys.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]