Research Article | DOI: https://doi.org/10.31579/2578-8949/213
1Department of Dermatology, El-Aml Specialized Hospital, Cairo, Egypt.
2 Department of Dermatology, Al-Haud Al-Marsoud Hospital, Cairo, Egypt.
3 Department of Dermatology, Zagazig General Hospital, Cairo, Egypt.
*Corresponding Author: Ahmed Adel Ali Ali, Department of Dermatology, El-Aml Specialized Hospital, Cairo, Egypt.
Citation: Ahmed Adel Ali Ali, Fatema Saber, Marwa Mahdy, (2022), COVID-19 Pandemic and Psoriasis: Effects on Disease Severity, Mental Health, and Treatment Adherence: A Multicenter Cross-Sectional Observational Study, Dermatology and Dermatitis, 7(3); DOI:10.31579/2578-8949/213
Copyright: © 2022, Ahmed Adel Ali Ali. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 07 November 2022 | Accepted: 18 November 2022 | Published: 25 November 2022
Keywords: psoriasis; covid-19; lockdown; mental health; quality of life; treatment adherence; anxiety; depression
Background: Psoriasis is a chronic immune-mediated inflammatory disease associated with significant physical, psychological, and social burden. The COVID-19 pandemic and lockdown measures created major challenges for patients with chronic diseases through healthcare disruption, limited medication accessibility, financial difficulties, and increased psychological stress, which may have negatively affected psoriasis severity and patient well-being.
Objective: to investigate the impact of the COVID-19 pandemic and lockdown on disease severity, mental health, quality of life, treatment accessibility, coping strategies, and financial burden among patients with psoriasis.
Methods: A multicenter cross-sectional observational study was conducted on 141 psoriasis patients attending the hospitals. Sociodemographic, clinical, psychological, and financial data were collected through patient interviews and medical records. Disease severity was assessed using Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Psoriasis Disability Index (PDI). Psychological assessment included Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Perceived Stress Scale (PSS). Health-related quality of life was evaluated using the SF-36 questionnaire.
Results: The mean age of participants was 41.19 ± 13.68 years, and 55.3% were males. Psoriasis symptoms worsened moderately to severely in 64.5% of patients during lockdown. Significant increases were observed in PASI, BSA, and PDI scores after lockdown (p<0.05). Moderate anxiety was reported in 59.6% of patients, while 41.1% experienced high stress levels. Significant negative correlations were found between SF-36 scores and anxiety, depression, and stress scores (p<0.001). Difficulties obtaining medications and healthcare services were reported by 68.8% and 95.7% of patients, respectively. Logistic regression identified higher BMI, anxiety severity, financial burden, and lower quality of life scores as significant predictors of worsening psoriasis symptoms.
Conclusions: The COVID-19 pandemic had a substantial negative impact on psoriasis severity, mental health, healthcare accessibility, and quality of life. Multidisciplinary management, psychological support, and improved healthcare accessibility are essential to optimize psoriasis care during future public health crises.
Psoriasis is a chronic immune-mediated inflammatory skin disease that affects patients physically, psychologically, and socially, resulting in substantial impairment in health-related quality of life. The disease is characterized by a relapsing and remitting course and is frequently associated with several systemic co-morbidities including obesity, hypertension, diabetes mellitus, cardiovascular diseases, and psoriatic arthritis. In addition to its physical manifestations, psoriasis has a considerable psychological burden, as patients commonly experience anxiety, depression, stress, social stigma, and impaired emotional well-being. Therefore, successful psoriasis management requires continuous medical care, treatment adherence, psychosocial support, and regular follow-up.
The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic created unprecedented challenges for healthcare systems worldwide, particularly for patients with chronic diseases requiring long-term management. Lockdown measures, social isolation, fear of infection, transportation restrictions, financial instability, healthcare disruption, and limited access to medications negatively affected patients with psoriasis. Moreover, concerns regarding the safety of immunosuppressive therapies during the pandemic contributed to treatment interruption and reduced healthcare utilization, which may have resulted in worsening disease severity and impaired quality of life.
Although several studies evaluated the impact of COVID-19 on psoriasis patients, most focused on limited aspects such as treatment adherence, biologic therapy safety, or psychological distress separately. There remains limited comprehensive data evaluating the combined clinical, psychological, social, and financial impact of the pandemic on psoriasis patients, especially in developing countries and Middle Eastern populations. Furthermore, few studies simultaneously assessed disease severity, mental health, quality of life, coping strategies, healthcare accessibility, and financial burden within the same patient population. This represents an important literature gap requiring further investigation.
The novelty of our study lies in providing a comprehensive multidimensional assessment of psoriasis patients during the COVID-19 pandemic by evaluating physical health, psychological burden, quality of life, coping strategies, healthcare accessibility, medication adherence, and financial impact together in one Egyptian cohort. In addition, the study compared several clinical and laboratory parameters before and after lockdown, allowing objective assessment of the pandemic’s effect on psoriasis outcomes.
Therefore, our study was performed to investigate the overall impact of the COVID-19 pandemic and lockdown on patients with psoriasis. The study specifically aimed to assess the effects of the pandemic on disease severity, psychological and emotional health, health-related quality of life, coping mechanisms, healthcare accessibility, treatment adherence, and financial burden among studied psoriasis patients.
Patients And Methods
This multicenter cross-sectional observational study was conducted on 141 patients clinically diagnosed with psoriasis attending the Dermatology outpatient clinics of El-Aml Specialized Hospital, Al-Haud Al-Marsoud Hospital, and Zagazig General Hospital, Egypt, during the period from March 2020 to May 2022 to investigate the impact of the COVID-19 pandemic and lockdown on patients with psoriasis. Eligible patients were identified through the hospital data registry and had attended the unit during the period from March 2020 to May 2022. All procedures were carried out in accordance with ethical standards for human research.
Inclusion Criteria
Participants were selected according to predefined inclusion criteria. Eligible participants were adult patients aged 18 years or older with a confirmed clinical diagnosis of psoriasis who had regularly attended the hospitals during the year preceding the COVID-19 lockdown in Egypt. Patients were required to have complete medical records and valid contact information to allow communication during the study period. In addition, only patients who were willing to participate in the psychosocial evaluation and provide informed consent were included in the study.
Exclusion Criteria
Patients were excluded if their medical records contained invalid or outdated contact information or lacked sufficient baseline clinical data. Patients who refused participation in the psychosocial assessment were also excluded. Additional exclusion criteria included the presence of other dermatological diseases that could affect physical or emotional health and interfere with study assessment, intellectual disability or major cognitive impairment preventing questionnaire completion, and patients with major psychiatric disorders.
1. Baseline Assessment and Data Collection
All included patients underwent detailed assessment through review of medical records and direct patient interviews. Sociodemographic data including age, gender, residence, occupation, marital status, and annual income were collected. Detailed clinical history was obtained with special emphasis on psoriasis type, disease course, duration, associated co-morbidities, treatment history, and accessibility to healthcare services and medications during lockdown.
Clinical evaluation included assessment of psoriasis severity using Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Psoriasis Disability Index (PDI). Anthropometric measurements including weight, body mass index (BMI), and waist circumference were also recorded before and after lockdown. Laboratory investigations including complete blood count (CBC), liver function tests, kidney function tests, fasting blood glucose, HbA1c, and lipid profile were reviewed and compared before and after lockdown.
2. Psychological and Quality of Life Assessment
Psychological and emotional assessment was performed using validated questionnaires. Anxiety levels were assessed using the Beck Anxiety Inventory (BAI), while depressive symptoms were evaluated using the Beck Depression Inventory (BDI). Stress levels were assessed using the Perceived Stress Scale (PSS). Health-related quality of life was evaluated using the Short Form-36 (SF-36) questionnaire, which assessed physical, emotional, social, and mental health domains. In addition, coping strategies adopted by psoriasis patients during the pandemic were evaluated using coping assessment questionnaires covering both adaptive and maladaptive coping mechanisms.
3. Assessment of Healthcare Accessibility and Financial Impact
Patients were interviewed regarding accessibility to healthcare services and medication availability during the COVID-19 lockdown. Data regarding difficulties obtaining medications from KAPU, inability to attend follow-up visits, transportation restrictions, fear of infection, financial difficulties, and healthcare service disruption were documented. The financial impact of the pandemic on work status, income, savings, financial obligations, and ability to obtain healthcare services was also assessed.
Sample Size
The study included 141 psoriasis patients. The sample size was considered adequate to evaluate the clinical, psychological, social, and financial impact of the COVID-19 pandemic on psoriasis patients and to allow appropriate statistical analysis of the studied variables.
Ethical Considerations
All participants were informed about the objectives and procedures of the study before enrollment. Written informed consent was obtained from all patients or their legal guardians prior to participation. Confidentiality and privacy of patient data were maintained throughout the study period.
Data were analyzed using the Statistical Package for Social Science (SPSS) software version 24. Qualitative variables were presented as frequencies and percentages, while quantitative variables were expressed as mean ± standard deviation (SD) or median and interquartile range (IQR) when appropriate. Paired sample t-test was used to compare quantitative variables before and after lockdown, while Chi-square test was applied for comparison of categorical variables. Correlation analysis was performed using Pearson correlation coefficient. Logistic regression analysis was conducted to identify independent predictors of worsening psoriasis symptoms. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A p-value less than 0.05 was considered statistically significant.
The results of the present study are demonstrated in the following tables.
Table (1) demonstrated that the mean age of the studied participants was 41.19 ± 13.68 years. Males represented 55.3% of the studied population, while females represented 44.7%. Rural residents constituted 51.8% of participants, whereas 48.2% were urban residents. Most participants were working (68.1%) and married (80.1%). The median annual income was 24,000 Egyptian pounds.
| Frequency | Percent | ||
| Age; (years) | Mean ±SD | 41.19 ±13.68 | |
| Gender | Female | 63 | 44.7 |
| Male | 78 | 55.3 | |
| Residence | Urban | 68 | 48.2 |
| Rural | 73 | 51.8 | |
| Profession | Working | 96 | 68.1 |
| Not-Working | 45 | 31.9 | |
| Marital Status | Married | 113 | 80.1 |
| Single | 24 | 17.0 | |
| Widow | 2 | 1.4 | |
| Divorced | 2 | 1.4 | |
| Annual Income$ | Median (IQR) | 24000.00 (18000.00) |
Table 1: Baseline data of the studied participants; (N= 141)
$the annual income was calculated for (96) participants only.
Data is presented as N (%) for qualitative data.
Mean ±SD for normally distributed quantitative data.
Median and interquartile range (IQR) for non-normally distributed quantitative data
Table (2) showed that classic psoriasis was the most prevalent clinical type among studied patients (84.4%), followed by scalp psoriasis (61.7%), nail psoriasis (22%), and flexural psoriasis (19.1%). Palmoplantar psoriasis was present in 10.6% of participants, while guttate, erythrodermic, pustular psoriasis, and chronic palmoplantar pustulosis were less frequent.
| Frequency | Percent | |
| Classic | 119 | 84.4 |
| Scalp | 87 | 61.7 |
| Flexural | 27 | 19.1 |
| Nail | 31 | 22.0 |
| Guttate | 8 | 5.7 |
| Erythrodermic | 3 | 2.1 |
| Palmoplantar | 15 | 10.6 |
| Pustular | 3 | 2.1 |
| Chronic PP Pustulosis | 2 | 1.4 |
Table 2: Clinical types of psoriasis among studied participants; (N=141)
N.B: Patient could have more than one psoriasis type at the same time.
Data is presented as N (%) for qualitative data.
Table (3) demonstrated that more than half of the studied psoriasis patients (56%) had a progressive disease course, while 42.6% experienced remission and exacerbation episodes. Only 1.4% showed a regressive disease course.
| Frequency | Percent | ||
| Coarse | Regressive | 2 | 1.4 |
| Progressive | 79 | 56.0 | |
| Remission and exacerbation | 60 | 42.6 | |
| Total | 141 | 100.0 | |
Table 3: Disease coarse among studied participants; (N= 141)
Covid-19 Pandemic Lockdown Burden on Physical Health of Patients with Psoriasis
Table (4) demonstrated worsening of psoriasis symptoms during the lockdown period. Moderate worsening was reported in 31.9% of patients, while 32.6% reported severe worsening. Only 18.4% reported no change in symptoms.
| Frequency | Percent | ||
| Change in Psoriasis Symptoms | No change | 26 | 18.4 |
| A Little worse | 24 | 17.0 | |
| Moderately worse | 45 | 31.9 | |
| A Lot worse | 46 | 32.6 | |
| Total | 141 | 100.0 | |
Table 4: Change in Psoriasis Symptoms among studied participants.
Table (5) showed that itching symptoms increased during lockdown among most studied patients. Severe increase in itching was reported by 40.4% of participants, while 27% experienced moderate increase. Only 15.6% reported no change in itching severity.
| Frequency | Percent | ||
| Itching | No Change | 22 | 15.6 |
| Little increase | 24 | 17.0 | |
| Moderate increase | 38 | 27.0 | |
| Lot increase | 57 | 40.4 | |
| Total | 141 | 100.0 | |
Table 5: Change in Itching Symptom among studied participants
Table (6) demonstrated that 36.9% of psoriasis patients had associated co-morbidities before lockdown, whereas 63.1% had no associated co-morbid conditions.
| Frequency | Percent | ||
| Co-morbidities | No | 89 | 63.1 |
| Yes | 52 | 36.9 | |
| Total | 141 | 100.0 | |
Table 6: Associated Co-morbidities among studied participants before lockdown; (N= 141)
Table (7) demonstrated that hypertension was the most prevalent co-morbidity among studied patients (12.1%), followed by diabetes mellitus (10.6%) and hepatitis C virus infection (7.1%). Other co-morbidities were less frequent.
| Frequency | Percent | |
| HTN | 17 | 12.10 |
| DM | 15 | 10.60 |
| HCV | 10 | 7.10 |
| Ovarian Cyst | 4 | 2.80 |
| Fatty Liver | 2 | 1.40 |
| Kidney Stones | 3 | 2.10 |
| Hypothyroidism | 3 | 2.10 |
| IBS | 6 | 4.30 |
| Benign Prostatic Hyperplasia | 2 | 1.40 |
| Cholecystitis | 0 | 0.00 |
| Osteoporosis | 1 | 0.70 |
| Osteoarthritis | 1 | 0.70 |
| Gastritis | 2 | 1.40 |
Table 7: Types of Associated Co-morbidities
N.B: Patient could have more than one co-morbidity at the same time.
Data is presented as N (%) for qualitative data.
Table (8) showed that 18.4% of participants developed new associated co-morbidities after lockdown, while the majority of patients (81.6%) did not report newly developed co-morbid conditions.
| Frequency | Percent | ||
| New Co-morbidities | No | 115 | 81.60 |
| Yes | 26 | 18.40 | |
| Total | 141 | 100.0 | |
Table 8: New Associated Co-morbidities among studied participants after lockdown; (N= 141)
Table (9) demonstrated no statistically significant differences in anthropometric measures before and after lockdown. Weight, BMI, and waist circumference showed minimal changes with p-values greater than 0.05.
| Mean ±SD | 95% CI for Mean | Minimum | Maximum | p-value | ||
| Lower Bound | Upper Bound | |||||
| Weight (kg); | ||||||
| Before Lockdown | 79.00 ±18.44 | 75.92 | 82.07 | 40 | 144 | 0.82 |
| After Lockdown | 79.49 ±18.07 | 76.48 | 82.5 | 40 | 146 | |
| BMI (kg/m2) | ||||||
| Before Lockdown | 28.69 ±7.08 | 27.5 | 29.87 | 15.2 | 47 | 0.861 |
| After Lockdown | 28.83 ±6.85 | 27.69 | 29.97 | 15.2 | 47.7 | |
| Waist circumference (cm); | ||||||
| Before Lockdown | 97.64 ±17.59 | 94.71 | 100.57 | 53 | 143 | 0.726 |
| After Lockdown | 98.38 ±17.68 | 95.43 | 101.32 | 53 | 146 | |
Table 9: Comparison of anthropometric measures among Studied Psoriasis Patients before and after Lockdown
Data is presented as Mean ±SD.
Statistical analysis carried out by: Paired Sample-t test analysis.
*p-value ≤0.05 is considered statistically significant.
Table (10) demonstrated significant increases in overall laboratory abnormalities after lockdown compared with before lockdown (46.8% vs. 31.2%, p=0.010). CBC abnormalities also significantly increased after lockdown (14.9% vs. 6.4%, p=0.016). Other laboratory parameters showed no statistically significant differences.
| Timing | p-value | |||
| Before Lockdown | After Lockdown | |||
| Labs | Normal | 97 (68.8) | 75 (53.2) | 0.010* |
| Abnormal | 44 (31.2) | 66 (46.8) | ||
| CBC | Normal | 132 (93.6) | 120 (85.1) | 0.016* |
| Abnormal | 9 (6.4) | 21 (14.9) | ||
| Liver | Normal | 138 (97.9) | 138 (97.9) | 0.658 |
| Abnormal | 3 (2.1) | 3 (2.1) | ||
| Kidney | Normal | 140 (99.3) | 137 (97.2) | 0.185 |
| Abnormal | 1 (0.7) | 4 (2.8) | ||
| Lipid Profile | Normal | 109 (77.3) | 98 (69.5) | 0.089 |
| Abnormal | 32 (22.7) | 43 (30.5) | ||
| FBG | Normal | 133 (94.3) | 125 (88.7) | 0.067 |
| Abnormal | 8 (5.7) | 16 (11.3) | ||
| HbA1c | Normal | 138 (97.9) | 133 (94.3) | 0.109 |
| Abnormal | 3 (2.1) | 8 (5.7) | ||
Table 10: Comparison of laboratory assessment among studied psoriasis patients before and after Lockdown
Data is presented as N (%) for qualitative data.
Statistical analysis carried out by: Chi-Square test analysis.
*p-value ≤0.05 is considered statistically significant.
Table (11) demonstrated significant worsening in psoriasis severity scores after lockdown. BSA significantly increased from 12.42 ± 14.59 to 17.17 ± 22.40 (p=0.014), PDI increased from 12.42 ± 9.94 to 13.63 ± 9.71 (p=0.040), and PASI increased from 6.30 ± 5.76 to 7.42 ± 6.69 (p=0.037).
| Mean ±SD | 95% CI for Mean | Minimum | Maximum | p-value | ||
| Lower Bound | Upper Bound | |||||
| BSA | ||||||
| Before Lockdown | 12.42 ±14.59 | 9.64 | 14.75 | 0.5 | 77 | 0.014* |
| After Lockdown | 17.17 ±22.40 | 9.95 | 15.63 | 0 | 90 | |
| PDI | ||||||
| Before Lockdown | 12.42 ±9.94 | 11.11 | 14.44 | 0 | 43 | 0.040* |
| After Lockdown | 13.63 ±9.71 | 12.29 | 15.55 | 0 | 39 | |
| PASI | ||||||
| Before Lockdown | 6.30 ±5.76 | 5.38 | 7.48 | 0.2 | 35.6 | 0.037* |
| After Lockdown | 7.42 ±6.69 | 5.75 | 7.81 | 0 | 31.2 | |
Table 11: Comparison of clinical assessment scores of psoriasis disease among Studied Psoriasis Patients before and after Lockdown
BSA: Body Surface Area; PDI: Psoriasis disability index; PASI: Psoriasis Area and Severity Index
Data is presented as Mean ±SD.
Statistical analysis carried out by: Paired Sample-t test analysis.
*p-value ≤0.05 is considered statistically significant.
Table (12) demonstrated significant worsening in psoriatic arthritis scores after lockdown. The percentage of patients with normal findings decreased from 70.2?fore lockdown to 39.7?ter lockdown (p=0.001).
| Timing | p-value | |||
| Before Lockdown | After Lockdown | |||
| Psoriatic Arthritis | Normal | 99 (70.2) | 56 (39.7) | 0.001* |
| 1 | 20 (14.2) | 42 (29.8) | ||
| 2 | 11 (7.8) | 24 (17.0) | ||
| 3 | 7 (5.0) | 12 (8.5) | ||
| 4 | 3 (2.1) | 3 (2.1) | ||
| 5 | 1 (0.7) | 4 (2.8) | ||
Table 12: Psoriatic Arthritis Score Comparison among Studied Psoriasis Patients before and after Lockdown
Data is presented as N (%) for qualitative data.
Statistical analysis carried out by: Chi-Square test analysis.
*p-value ≤0.05 is considered statistically significant.
Assessment of Emotional and Mental Health among Studied Psoriasis Patients
Table (13) showed that moderate anxiety was present in 59.6% of studied patients, while potentially concerning anxiety levels were reported in 12.1%. Regarding depression, 21.3% of patients had borderline clinical depression, 21.3% had moderate depression, and 17% had severe to extreme depression.
| Frequency | Percent | ||
| BAI | Low anxiety | 40 | 28.4 |
| Moderate anxiety | 84 | 59.6 | |
| Potentially concerning levels of anxiety | 17 | 12.1 | |
| Mean ±SD | 25.80 ±8.08 | ||
| Range (Min – Max) | (4 – 44) | ||
| BDI | Normal | 35 | 24.8 |
| Mild mood disturbance | 22 | 15.6 | |
| Borderline clinical depression | 30 | 21.3 | |
| Moderate depression | 30 | 21.3 | |
| Severe depression | 12 | 8.5 | |
| Extreme depression | 12 | 8.5 | |
| Mean ±SD | 20.62 ±11.82 | ||
| Range (Min – Max) | (2 – 54) | ||
Table 13: Prevalence of Depression and Anxiety according to Beck depression inventory and Beck anxiety inventory scores among studied population
(BDI): Beck depression inventory, (BAI): Beck anxiety inventory
Table (14) demonstrated that 49.6% of participants experienced moderate stress levels, while 41.1% reported high stress levels according to the Perceived Stress Scale.
| Frequency | Percent | ||
| PSS | Low stress | 13 | 9.2 |
| Moderate stress | 70 | 49.6 | |
| High stress | 58 | 41.1 | |
| Mean ±SD | 24.44 ±7.27 | 100.0 | |
| Range (Min – Max) | (4 – 44) | ||
Table 14: Prevalence of Stress according to Perceived stress scale scores among studied population
(PSS): Perceived stress scale
Table (15) demonstrated impaired health-related quality of life among studied psoriasis patients. The highest mean score was observed in physical functioning (75.85 ± 22.43), while the lowest score was recorded in role emotional (34.74 ± 39.61). The mean total SF-36 score was 51.18 ± 18.60.
| Minimum | Maximum | Mean | SD | |
| Physical Functioning (PF) | 0 | 100 | 75.85 | 22.43 |
| Role Physical (RP) | 0 | 100 | 41.48 | 39.39 |
| Role Emotional (RE) | 0 | 100 | 34.74 | 39.61 |
| Vitality (VT) | 0 | 90 | 40.92 | 17.91 |
| Mental Health (MH) | 0 | 96 | 43.74 | 20.79 |
| Social Functioning (SF) | 0 | 100 | 63.74 | 27.68 |
| Bodily Pain (BP) | 0 | 100 | 62.57 | 29.37 |
| General Health (GH) | 5 | 100 | 46.38 | 22.01 |
| Total SF36 Score | 3.13 | 94.25 | 51.18 | 18.60 |
Table 15: Health related quality of life assessment among studied population
Table (16) demonstrated statistically significant negative correlations between total SF-36 scores and psychological measures. SF-36 negatively correlated with BDI scores (r=-0.319, p<0.001), BAI scores (r=-0.368, p<0.001), and PSS scores (r=-0.479, p<0.001).
| Total SF36 | ||
| BDI Scire | Pearson Correlation | -0.319** |
| P-Value | <0> | |
| BAI Score | Pearson Correlation | -0.368** |
| P-Value | <0> | |
| PSS Score | Pearson Correlation | -0.479** |
| P-Value | <0> | |
Table 16: Correlation between Quality of Life as Assessed by Sf-36 with Emotional and Mental Health among Studied Psoriasis Patients; (N= 141)
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
(BDI): Beck depression inventory, (BAI): Beck anxiety inventory, (PSS): Perceived stress scale
Table (17) demonstrated that religion was the most commonly used coping strategy among psoriasis patients (6.98 ± 1.50), followed by planning, active coping, instrumental support, emotional support, and acceptance. Substance use was the least utilized coping strategy.
| Minimum | Maximum | Mean | SD | |
| Behavioral disengagement | 2.00 | 8.00 | 3.40 | 1.61 |
| Substance Use | 1.00 | 7.00 | 2.17 | 0.72 |
| Venting | 2.00 | 8.00 | 5.21 | 1.76 |
| Denial | 2.00 | 8.00 | 4.00 | 1.83 |
| Self-Blame | 2.00 | 8.00 | 4.87 | 2.16 |
| Self-Distraction | 2.00 | 8.00 | 5.17 | 1.96 |
| Active Coping | 2.00 | 8.00 | 5.26 | 1.89 |
| Emotional Support | 2.00 | 8.00 | 5.14 | 2.04 |
| Instrumental Support | 2.00 | 8.00 | 5.19 | 2.13 |
| Positive reframing | 2.00 | 8.00 | 3.63 | 1.76 |
| Planning | 2.00 | 8.00 | 5.41 | 1.72 |
| Humor | 2.00 | 8.00 | 3.99 | 2.10 |
| Acceptance | 2.00 | 8.00 | 5.07 | 2.10 |
| Religion | 2.00 | 8.00 | 6.98 | 1.50 |
Table 17: Ways of coping in patients with psoriasis; (N= 141)
Table (18) demonstrated significant positive correlations between perceived stress and behavioral disengagement, self-blame, and self-distraction. Significant negative correlations were observed between stress and venting, positive reframing, planning, humor, and acceptance.
| PSS Score | ||
| Behavioral Disengagement | Pearson Correlation | 0.212* |
| P-Value | 0.012* | |
| Substance Use | Pearson Correlation | 0.040 |
| P-Value | 0.641 | |
| Venting | Pearson Correlation | -0.216** |
| P-Value | 0.010* | |
| Denial | Pearson Correlation | 0.084 |
| P-Value | 0.322 | |
| Self-Blame | Pearson Correlation | 0.376** |
| P-Value | <0> | |
| Self-Distraction | Pearson Correlation | 0.168* |
| P-Value | 0.046* | |
| Active Coping | Pearson Correlation | -0.041 |
| P-Value | 0.627 | |
| Emotional Support | Pearson Correlation | 0.039 |
| P-Value | 0.647 | |
| Instrumental Support | Pearson Correlation | 0.038 |
| P-Value | 0.656 | |
| Positive Reframing | Pearson Correlation | -0.248** |
| P-Value | 0.003* | |
| Planning | Pearson Correlation | -0.212* |
| P-Value | 0.011* | |
| Humor | Pearson Correlation | -0.169* |
| P-Value | 0.045* | |
| Acceptance | Pearson Correlation | -0.296** |
| P-Value | <0> | |
| Religion | Pearson Correlation | -0.086 |
| P-Value | 0.312 | |
Table 18: Correlation between PSS and Ways of coping in patients with psoriasis; (N= 141)
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
(PSS): Perceived stress scale
Accessibility to Medical Prescriptions, Accessibility to Health Care Services, And Financial Affection among Studied Psoriasis Patients
Table (19) demonstrated that 61.7% of patients usually received treatment from KAPU before lockdown. Difficulties obtaining medications during lockdown were reported by 56.7% of patients, while 68.8% experienced problems purchasing medications mainly due to financial difficulties, inability to reach healthcare, and medication unavailability.
| Frequency | Percent | |
| 87 | 61.7 |
| 80 | 56.7 |
| 97 | 68.8 |
| a) Not available | 36 | 25.5 |
| b) Cannot reach healthcare | 48 | 34.0 |
| c) Financial disability | 78 | 55.3 |
Table 19: Medication Adherence among studies psoriasis patients; (N= 141)
Table (20) demonstrated that 95.7% of studied patients experienced problems with follow-up at KAPU during lockdown. Fear of the pandemic was the most commonly reported cause (66.7%), followed by transportation restrictions (50.4%) and financial difficulties (42.6%).
| Problem with FU at KAPU | Frequency | Percent |
| No Problems | 6 | 4.30 |
| Problems* | 135 | 95.7 |
| a) Afraid of pandemic | 94 | 66.7 |
| b) Because of lockdown or transportation | 71 | 50.4 |
| c) Financial | 60 | 42.6 |
| d) Needed health services were not found during lockdown | 23 | 16.3 |
Table 20: Problem with follow-up at KAPU among studies psoriasis patients; (N= 141)
*N. B: Patient could have more than one problem with follow-up at the same time.
Table (21) demonstrated marked financial impact of the COVID-19 pandemic on psoriasis patients. Work was affected in 77.1% of employed participants, income was affected in 79.1%, savings were affected in 77%, and financial obligations were affected in 75% of patients.
| Frequency | Percent | ||
| Work affection | Not Affected | 22 | 22.9 |
| Affected | 74 | 77.1 | |
| Total | 96 | 68.1 | |
| Income affection* | Not Affected | 28 | 20.9 |
| Affected | 106 | 79.1 | |
| Total | 134 | 100.0 | |
| Savings affection* | Not Affected | 31 | 23.0 |
| Affected | 104 | 77.0 | |
| Total | 135 | 100.0 | |
| Financial obligations affection* | Not Affected | 34 | 25.0 |
| Affected | 102 | 75.0 | |
| Total | 136 | 100.0 | |
| Financial status affected getting drugs or health care | Not Affected | 48 | 34.0 |
| Affected | 93 | 66.0 | |
| Total | 141 | 100.0 | |
Table 21: Financial affection among studied psoriasis patients; (N= 141)
*N. B: for income affection, the total number of participants who answered the question was 134, and 7 missing data. Savings affection, the total number of participants who answered the question was 135, and 6 missing data. Financial obligations affection the total number of participants who answered the question was 136, and 5 missing data.
Table (22) demonstrated that BMI was significantly higher among patients with moderate-to-severe worsening of psoriasis symptoms compared with patients with no or little worsening (31.87 ± 7.99 vs. 27.26 ± 7.13, p<0.001). Other variables showed no statistically significant differences.
Change in Psoriasis Symptoms among Studied Participants
The following tables compare the relation of different studied factors with the change in Psoriasis Symptoms among studied participants:
| Changes in Psoriasis symptoms | p-value | |||
| No to Little worse N= 71 | Moderate to severe worse N= 70 | |||
| Age | 41.38 ±13.02 | 41.00 ±14.40 | 0.870 | |
| Gender | Female | 28 (39.4) | 35 (50.0) | 0.137 |
| Male | 43 (60.6) | 35 (50.0) | ||
| Residence | Urban | 35 (49.3) | 33 (47.1) | 0.465 |
| Rural | 36 (50.7) | 37 (52.9) | ||
| Occupation | Working | 53 (74.6) | 43 (61.4) | 0.066 |
| Not-Working | 18 (25.4) | 27 (38.6) | ||
| Income | 33197.41 ±25307.95 | 30157.62 ±22541.45 | 0.542 | |
| BMI | 27.26 ±7.13 | 31.87 ±7.99 | <0> | |
| BSA | 12.45 ±16.50 | 11.92 ±14.20 | 0.837 | |
| PDI | 12.09 ±9.25 | 13.45 ±10.69 | 0.421 | |
| PASI | 6.73 ±7.10 | 6.12 ±5.35 | 0.566 | |
Table 22: Basic Characteristics among studied population according to changes in psoriasis symptoms
Table (23) demonstrated significantly higher BDI, BAI, and PSS scores among patients with moderate-to-severe worsening of psoriasis symptoms compared with those with no or little worsening (p<0.05).
| Changes in Psoriasis symptoms | p-value | |||
| No to Little worse N= 71 | Moderate to severe worse N= 70 | |||
| BDI Score | Mean ±SD | 17.89 ±10.79 | 23.40 ±12.24 | 0.005* |
| Range (Min - Max) | 3.00 - 50.00 | 2.00 - 54.00 | ||
| BAI Score | Mean ±SD | 23.69 ±7.49 | 27.97 ±7.49 | 0.001* |
| Range (Min - Max) | 4.00 - 44.00 | 5.00 - 38.00 | ||
| PSS Score | Mean ±SD | 23.18 ±7.95 | 25.88 ±6.31 | 0.027* |
| Range (Min - Max) | 4 – 44 | 5 – 38 | ||
Table 23: Beck depression inventory and Beck anxiety inventory scores among studied population according to changes in psoriasis symptoms
(BDI): Beck depression inventory, (BAI): Beck anxiety inventory.
Table (24) demonstrated significantly lower physical functioning, social functioning, and total SF-36 scores among patients with moderate-to-severe worsening of psoriasis symptoms compared with patients with no or little worsening.
| Changes in Psoriasis symptoms | p-value | |||
| No to Little worse N= 71 | Moderate to severe worse N= 70 | |||
| Physical Functioning (PF) | Mean ±SD | 79.71 ±20.14 | 71.92 ±24.05 | 0.039* |
| (Min - Max) | 25.00 - 100.00 | 0.00 - 100.00 | ||
| Role Physical (RP) | Mean ±SD | 45.77 ±40.52 | 37.14 ±38.00 | 0.194 |
| (Min - Max) | 0.00 - 100.00 | 0.00 - 100.00 | ||
| Role Emotional (RE) | Mean ±SD | 38.02 ±39.56 | 31.42 ±39.67 | 0.324 |
| (Min - Max) | 0.00 - 100.00 | 0.00 - 100.00 | ||
| Vitality (VT) | Mean ±SD | 43.66 ±15.21 | 38.14 ±20.02 | 0.067 |
| (Min - Max) | 10.00 - 90.00 | 0.00 - 90.00 | ||
| Mental Health (MH) | Mean ±SD | 45.69 ±19.19 | 41.77 ±22.27 | 0.265 |
| (Min - Max) | 4.00 - 96.00 | 0.00 - 92.00 | ||
| Social Functioning (SF) | Mean ±SD | 68.83 ±24.89 | 58.57 ±29.45 | 0.027* |
| (Min - Max) | 12.50 - 100.00 | 0.00 - 100.00 | ||
| Bodily Pain (BP) | Mean ±SD | 63.52 ±30.44 | 61.60 ±28.44 | 0.700 |
| (Min - Max) | 0.00 - 100.00 | 0.00 - 100.00 | ||
| General Health (GH) | Mean ±SD | 48.59 ±22.31 | 44.14 ±21.63 | 0.232 |
| (Min - Max) | 10.00 - 100.00 | 5.00 - 100.00 | ||
| Total Score | Mean ±SD | 54.22 ±58.38 | 48.09 ±52.67 | 0.049* |
| (Min - Max) | 19.19 - 92.25 | 3.13 - 94.25 | ||
Table 24: Health related quality of life assessment among studied population according to changes in psoriasis symptoms
Table (25) demonstrated no statistically significant differences in coping strategies between patients with no-to-little worsening and those with moderate-to-severe worsening of psoriasis symptoms (p>0.05).
| Changes in Psoriasis symptoms | p-value | ||
| No to Little worse N= 71 | Moderate to severe worse N= 70 | ||
| Behavioral disengagement | 5.11 ±1.97 | 5.24 ±1.95 | 0.695 |
| Substance Use | 5.22 ±1.84 | 5.30 ±1.95 | 0.816 |
| Venting | 3.90 ±1.86 | 4.10 ±1.81 | 0.523 |
| Denial | 2.09 ±0.45 | 2.24 ±0.92 | 0.240 |
| Self-Blame | 5.39 ±1.89 | 4.88 ±2.17 | 0.141 |
| Self-Distraction | 5.30 ±2.10 | 5.08 ±2.17 | 0.536 |
| Active Coping | 3.63 ±1.74 | 3.17 ±1.44 | 0.089 |
| Emotional Support | 5.07 ±1.88 | 5.37 ±1.64 | 0.314 |
| Instrumental Support | 3.71 ±1.68 | 3.54 ±1.85 | 0.557 |
| Positive reframing | 5.36 ±1.67 | 5.45 ±1.79 | 0.756 |
| Planning | 4.32 ±2.20 | 3.65 ±1.95 | 0.090 |
| Humor | 5.11 ±2.06 | 5.04 ±2.16 | 0.845 |
| Acceptance | 6.78 ±1.56 | 7.18 ±1.41 | 0.117 |
| Religion | 4.97 ±2.24 | 4.78 ±2.09 | 0.612 |
Table 25: Ways of coping in patients with psoriasis according to changes in psoriasis symptoms
Table (26) demonstrated that BMI, anxiety severity, income affection, financial obligations affection, and total SF-36 score were significant independent predictors of worsening psoriasis symptoms according to logistic regression analysis. The overall regression model was statistically significant (p=0.013) with an overall prediction accuracy of 71.9%.
| B | p-value | OR | 95% C.I. for OR | ||||
| Lower | Upper | ||||||
| BMI | 0.112 | 0.003* | 1.119 | 1.039 | 1.205 | ||
| BDI Score | 0.007 | 0.119 | 1.007 | 0.964 | 1.052 | ||
| BAI Score | 0.017 | 0.014* | 1.017 | 0.949 | 1.091 | ||
| PSS Score | -0.099 | 0.145 | 0.906 | 0.794 | 1.034 | ||
| Receive drug from KAPU | 0.922 | 0.802 | 2.514 | 0.559 | 11.300 | ||
| Difficult to get drug from KAPU | -0.724 | 0.265 | 0.485 | 0.112 | 2.094 | ||
| Work affection | 0.463 | 0.163 | 1.589 | 0.252 | 10.030 | ||
| Income affection | -0.194 | 0.050* | 0.823 | 0.022 | 31.339 | ||
| Savings affection | -0.911 | 0.062 | 0.402 | 0.015 | 11.032 | ||
| Financial obligations affection | -0.376 | 0.049* | 0.687 | 0.062 | 7.641 | ||
| Total SF36 | -0.013 | 0.025* | 0.987 | 0.957 | 1.018 | ||
| Constant | -3.045 | 0.071 | |||||
Table 26: Logistic Regression analysis for patient-reported outcomes of psoriasis with other studied variables
Variable(s) entered on analysis: BMI, BDI Score, BAI Score, PSS Score, receive drug from KAPU before lockdown, difficult to get drug from KAPU during lock down, work affection, income affection, savings affection, financial obligations affection, Total SF36 score.
Psoriasis is a chronic immune-mediated inflammatory disease that affects patients physically, psychologically, and socially, leading to significant impairment in quality of life. The disease is commonly associated with several co-morbidities and requires long-term treatment, regular follow-up, and continuous psychosocial support. Due to its chronic relapsing nature and visible skin manifestations, psoriasis is frequently linked to anxiety, depression, stress, and social stigma.
The COVID-19 pandemic created major challenges for patients with chronic diseases, including psoriasis. Lockdown measures, fear of infection, healthcare disruption, transportation difficulties, financial burden, and limited access to medications negatively affected disease management and patient well-being. These factors may have contributed to worsening psoriasis symptoms, psychological distress, impaired quality of life, and treatment interruption during the pandemic period.
Despite increasing interest in the impact of COVID-19 on chronic diseases, there remains limited comprehensive data evaluating the combined clinical, psychological, social, and financial burden of the pandemic on psoriasis patients, particularly in Egyptian populations. Consequently, our study aimed to investigate the impact of the COVID-19 pandemic and lockdown on patients with psoriasis, with special emphasis on physical health, psychological status, quality of life, coping strategies, healthcare accessibility, medication adherence, and financial burden.
Our study included 141 psoriatic patients with a mean age of 41.19 ± 13.68 years, ranging from 18 to 70 years. Males represented 55.3% of the studied population, while females accounted for 44.7%. Additionally, 51.8% of participants were rural residents, 68.1% were employed, and 80.1% were married. The median annual income was 24,000 Egyptian pounds (IQR = 18,000). These findings are generally consistent with the study conducted by Oguz Topal et al. (2022), who evaluated 342 psoriasis patients during the COVID-19 pandemic and reported a mean age of 45.9 ± 14.2 years with a slight male predominance (53.2% males and 46.8?males). Similarly, Kartal et al. (2022) included 1827 psoriasis patients receiving immunosuppressive therapy and also demonstrated male predominance among studied patients.
In contrast, Mahil et al. (2021) reported different demographic characteristics in their multinational cross-sectional study involving 4043 psoriasis patients from 86 countries, where females represented 66.5% of participants. This difference may be attributed to the online self-reported nature of their survey and broader international representation. Meanwhile, Beytout et al. (2021) studied pediatric psoriasis patients and reported a lower mean age of 11.4 ± 3.5 years because their study specifically focused on children and adolescents during lockdown. The demographic similarities between our study and the Turkish studies suggest that psoriasis predominantly affected economically active middle-aged adults during the pandemic, increasing the psychosocial and financial burden on patients.
Regarding Clinical Characteristics of Psoriasis, our study demonstrated that classic plaque psoriasis was the predominant clinical type, affecting 84.4% of patients. Scalp psoriasis was reported in 61.7%, nail psoriasis in 22%, flexural psoriasis in 19.1%, and palmoplantar psoriasis in 10.6% of participants. Moreover, 56% of patients exhibited a progressive disease course, while 42.6% experienced remission and exacerbation episodes.
These findings closely resemble those reported by Oguz Topal et al. (2022), who found plaque psoriasis in 95.3% of studied patients, confirming that plaque psoriasis remained the dominant subtype during the pandemic period. Likewise, Beytout et al. (2021) observed that 71.7% of pediatric psoriasis patients had active psoriatic lesions during lockdown, emphasizing persistent disease activity despite age differences.
Additionally, Kartal et al. (2022) reported persistent disease activity among patients receiving immunosuppressive therapy and evaluated disease progression according to patient-reported outcomes and PASI scores. The consistency among studies indicates that psoriasis activity remained inadequately controlled during the pandemic, likely due to healthcare disruption, treatment interruption, and psychological stress.
Regarding Effect of Lockdown on Psoriasis Symptoms, our study demonstrated substantial worsening of psoriasis symptoms during the COVID-19 lockdown. Approximately one-third of participants (32.6%) reported that their psoriasis became “a lot worse,” while another 31.9% experienced “moderately worse” symptoms. Only 18.4% reported no change in symptoms. Furthermore, itching severity increased markedly, with 40.4% reporting a major increase in itching symptoms and 27% reporting moderate worsening.
Comparable findings were observed by Beytout et al. (2021), who reported worsening psoriasis in 47.3% of children during lockdown. The authors identified stress (48.8%) and treatment discontinuation (18.6%) as the major triggers for flare-ups. Similarly, Mahil et al. (2021) found that 42.7% of psoriasis patients experienced worsening disease during the pandemic. Moreover, Kartal et al. (2022) reported disease worsening in 24.2% of psoriasis patients and demonstrated that treatment dose reduction increased worsening risk by 3.26 times, while treatment discontinuation increased worsening risk by 8.71 times.
The similarity between our findings and previous studies strongly supports the hypothesis that lockdown-related stress, social isolation, treatment interruption, and reduced access to healthcare contributed significantly to psoriasis exacerbation during the pandemic.
Regarding Co-Morbidities Among Studied Patients, our study found that 36.9% of psoriasis patients had associated co-morbidities before lockdown, while 18.4?veloped new co-morbidities after lockdown. Hypertension was the most common co-morbidity (12.1%), followed by diabetes mellitus (10.6%) and hepatitis C virus infection (7.1%).
These findings are supported by Gisondi et al. (2020), who evaluated 5206 psoriasis patients receiving biologic therapy in Northern Italy and found high frequencies of hypertension (30.8%), obesity (25%), cardiovascular disease (12%), diabetes mellitus (12.2%), and psoriatic arthritis (27.6%). Similarly, Mahil et al. (2021) reported that 39.7% of psoriasis patients had at least one co-morbidity during the pandemic.
Furthermore, Beytout et al. (2021) documented co-morbidities in 17.4% of pediatric patients, mainly asthma and metabolic disorders, though at lower rates compared with adult studies. The increased prevalence of metabolic and cardiovascular diseases among psoriasis patients emphasizes their heightened vulnerability during COVID-19.
Regarding Anthropometric and Laboratory Changes, our study demonstrated no statistically significant changes in weight, BMI, or waist circumference before and after lockdown. Mean BMI increased minimally from 28.69 ± 7.08 kg/m² to 28.83 ± 6.85 kg/m² (p=0.861). However, patients with moderate-to-severe worsening of psoriasis had significantly higher BMI values (31.87 ± 7.99 kg/m²) compared with patients with mild or no worsening (27.26 ± 7.13 kg/m², p<0.001).
This finding agrees with Mahil et al. (2021), who identified obesity as a significant independent predictor of worsening psoriasis during the pandemic (OR=1.22). In addition, our study revealed a significant increase in abnormal laboratory findings after lockdown, particularly CBC abnormalities, which increased from 6.4?fore lockdown to 14.9?ter lockdown (p=0.016).
These laboratory deteriorations may reflect increased systemic inflammation, chronic stress, treatment interruption, or delayed medical follow-up during the pandemic.
Regarding Clinical Severity Scores, our study revealed significant worsening in psoriasis severity indices following lockdown. PASI scores significantly increased from 6.30 ± 5.76 before lockdown to 7.42 ± 6.69 after lockdown (p=0.037). Similarly, BSA significantly increased from 12.42 ± 14.59 to 17.17 ± 22.40 (p=0.014), while PDI scores increased from 12.42 ± 9.94 to 13.63 ± 9.71 (p=0.040).
Similarly, Oguz Topal et al. (2022) demonstrated that higher PASI scores negatively influenced treatment adherence and were associated with increased disease burden. Likewise, Kartal et al. (2022) confirmed that treatment discontinuation and dose reduction were strongly associated with worsening psoriasis severity.
The observed increase in PASI, BSA, and disability scores across studies highlights the substantial impact of healthcare interruption during lockdown on psoriasis control.
Regarding Psoriatic Arthritis Findings, our study demonstrated significant worsening in psoriatic arthritis manifestations after lockdown. Normal findings decreased from 70.2?fore lockdown to 39.7?ter lockdown (p=0.001), indicating increased joint involvement and disease activity.
Similarly, Gisondi et al. (2020) reported psoriatic arthritis in 27.6% of biologically treated psoriasis patients. Additionally, Oguz Topal et al. (2022) evaluated psoriatic arthritis among psoriasis patients receiving systemic therapies and highlighted its negative impact on treatment adherence and quality of life.
These findings suggest that delayed healthcare access and treatment interruption during lockdown may have contributed to worsening musculoskeletal symptoms among psoriasis patients.
Regarding Psychological and Emotional Impact, our study demonstrated a considerable psychological burden among psoriasis patients during the pandemic. Moderate anxiety affected 59.6% of participants, while moderate, severe, and extreme depression affected 21.3%, 8.5%, and 8.5% respectively. Additionally, 41.1% of patients experienced high perceived stress levels.
These findings are strongly supported by Mahil et al. (2021), who demonstrated that anxiety and depression were significantly associated with worsening psoriasis. Patients with worsening psoriasis showed positive mental health screening in 50.2% of cases compared with 28.8% among those without worsening disease. Furthermore, Beytout et al. (2021) identified stress as the most common trigger for psoriasis exacerbation during lockdown.
Similarly, Oguz Topal et al. (2022) used the Hospital Anxiety and Depression Scale (HADS) and demonstrated that psychological distress negatively affected treatment adherence during the pandemic. These findings confirm the close bidirectional relationship between psychological stress and psoriasis severity.
Regarding Health-Related Quality of Life, our study revealed substantial impairment in health-related quality of life among psoriasis patients. The mean total SF-36 score was 51.18 ± 18.60, while role emotional scored lowest (34.74 ± 39.61), indicating major emotional impairment. Moreover, SF-36 scores negatively correlated with anxiety (r=-0.368), depression (r=-0.319), and stress scores (r=-0.479), all with p<0.001.
Comparable findings were reported by Oguz Topal et al. (2022), who demonstrated impaired Dermatology Life Quality Index (DLQI) scores among psoriasis patients during the pandemic. Likewise, Mahil et al. (2021) emphasized the indirect morbidity of the pandemic, particularly worsening mental health and impaired quality of life among psoriasis patients.
These studies collectively demonstrate that COVID-19 negatively affected both physical and emotional dimensions of quality of life in psoriasis patients.
Regarding Coping Strategies, our study showed that religion (6.98 ± 1.50), planning (5.41 ± 1.72), acceptance (5.07 ± 2.10), and active coping (5.26 ± 1.89) were the most frequently utilized coping strategies among psoriasis patients. Furthermore, stress positively correlated with maladaptive coping mechanisms such as behavioral disengagement (r=0.212, p=0.012) and self-blame (r=0.376, p<0.001), while acceptance and positive reframing negatively correlated with stress.
Although the compared studies did not specifically assess coping strategies, Mahil et al. (2021) emphasized the importance of psychological support and holistic healthcare models during the pandemic. Our findings add important psychosocial dimensions regarding behavioral adaptation during health crises.
Regarding Accessibility to Healthcare and Medication, our study demonstrated major disruptions in healthcare access during lockdown. Difficulties obtaining medications from KAPU were reported by 56.7% of patients, while 68.8% experienced problems buying medications mainly due to financial difficulties (55.3%), healthcare inaccessibility (34%), and medication unavailability (25.5%).
Similarly, Oguz Topal et al. (2022) found that inability to attend hospital visits (19.2%), concern about COVID-19 infection (16.3%), physician-directed discontinuation (13.7%), and inability to access medications (7.3%) were major causes of treatment interruption. Likewise, Kartal et al. (2022) reported that inability to attend follow-up visits was the leading reason for treatment withdrawal during the pandemic.
Importantly, Beytout et al. (2021) highlighted the major role of teleconsultation, as 71.1% of consultations during lockdown were performed remotely. These findings emphasize the necessity of implementing telemedicine and remote healthcare systems during future pandemics.
Regarding Financial Impact of the Pandemic, our study revealed significant financial burdens among psoriasis patients. Work was negatively affected in 77.1% of employed patients, income reduction occurred in 79.1%, savings were affected in 77%, and financial obligations worsened in 75% of participants. Furthermore, 66% reported that financial difficulties negatively affected their ability to obtain medications and healthcare services.
Similarly, Mahil et al. (2021) found that shielding measures, employment disruptions, and psychological stress contributed significantly to worsening psoriasis during the pandemic. Additionally, Kartal et al. (2022) highlighted reduced healthcare access and treatment interruption caused by pandemic-related restrictions.
These findings demonstrate the profound socioeconomic consequences of the COVID-19 pandemic on psoriasis patients and their treatment continuity.
Regarding Factors Associated with Worsening Psoriasis Symptoms, our study demonstrated that higher BMI, anxiety, depression, stress, and impaired quality of life were significantly associated with worsening psoriasis symptoms. Patients with moderate-to-severe worsening had significantly higher BMI (31.87 ± 7.99 vs. 27.26 ± 7.13, p<0.001), BDI scores (23.40 ± 12.24 vs. 17.89 ± 10.79, p=0.005), BAI scores (27.97 ± 7.49 vs. 23.69 ± 7.49, p=0.001), and PSS scores (25.88 ± 6.31 vs. 23.18 ± 7.95, p=0.027).
These findings are consistent with Mahil et al. (2021), who identified obesity, anxiety, depression, female gender, and treatment non-adherence as major predictors of worsening psoriasis. Similarly, Kartal et al. (2022) demonstrated that treatment withdrawal significantly increased disease worsening risk.
Regarding Logistic Regression Analysis, our logistic regression analysis identified BMI, anxiety severity, financial affection, and lower SF-36 scores as significant independent predictors of worsening psoriasis symptoms. BMI significantly increased worsening risk (OR=1.119, p=0.003), while anxiety severity measured by BAI also predicted worsening disease (p=0.014).
These findings strongly agree with Mahil et al. (2021), who found that positive anxiety or depression screening doubled the odds of worsening psoriasis (OR=2.01), while treatment non-adherence increased worsening risk nearly threefold (OR=2.90). Additionally, Kartal et al. (2022) demonstrated that treatment withdrawal and dose reduction were strong predictors of psoriasis aggravation during the pandemic.
Clinical Implications
Our study demonstrated that the COVID-19 pandemic had a major negative impact on psoriasis patients at clinical, psychological, and social levels. Significant worsening was observed in psoriasis severity, itching symptoms, psoriatic arthritis manifestations, anxiety, depression, stress, and quality of life. These findings emphasize that psoriasis management should not focus only on skin manifestations but should include psychological assessment, emotional support, and social care. The study also highlighted the importance of maintaining continuous access to healthcare services and medications during health crises. Telemedicine and remote follow-up can play an important role in preventing treatment interruption and disease aggravation during future pandemics or lockdowns.
Strength Points
One of the main strengths of our study is the comprehensive evaluation of psoriasis patients during the COVID-19 pandemic. The study assessed multiple dimensions including clinical severity, laboratory findings, psychological health, quality of life, coping strategies, healthcare accessibility, and financial burden. Another strength is the use of validated assessment tools such as PASI, PDI, SF-36, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Perceived Stress Scale (PSS), which increased the reliability and accuracy of the findings. In addition, comparing patients before and after lockdown provided objective evidence regarding the impact of the pandemic on psoriasis outcomes.
Despite its strengths, our study had some limitations. The study was conducted at a single tertiary center with a relatively limited sample size, which may reduce the generalizability of the findings to other populations. The cross-sectional observational design also limits the ability to establish causal relationships between the pandemic and worsening psoriasis outcomes. Some data were based on patient self-reporting, which may have introduced recall bias, especially regarding symptom worsening, psychological status, and financial impact during lockdown. Furthermore, the absence of a healthy control group limited comparisons between psoriasis patients and the general population regarding psychological and social burden during the pandemic.
Our study concluded that the COVID-19 pandemic significantly affected patients with psoriasis physically, psychologically, socially, and financially. There was marked worsening in psoriasis severity scores, itching symptoms, psoriatic arthritis manifestations, and quality of life after lockdown. Anxiety, depression, and stress were highly prevalent among patients and were significantly associated with worsening psoriasis symptoms. Difficulties in accessing healthcare services, obtaining medications, and financial hardship further contributed to disease aggravation and impaired patient well-being. Logistic regression analysis identified higher BMI, anxiety severity, financial burden, and lower quality of life scores as important predictors of worsening psoriasis symptoms during the pandemic.
Based on our findings, multidisciplinary management approaches should be implemented for psoriasis patients, especially during public health emergencies. Routine screening for anxiety, depression, and stress should be integrated into dermatology practice with appropriate psychological support when needed. Telemedicine services and online consultations should be strengthened to maintain continuity of care during lockdowns or healthcare disruptions. Healthcare providers should educate patients regarding the importance of treatment adherence and reassure them about the safety of continuing prescribed therapies unless contraindicated. In addition, health authorities should improve medication availability and provide financial support for patients with chronic diseases during crises.
none
Author Contributions
Ahmed Adel Ali Ali contributed to study supervision, conception and design, data collection, statistical analysis, interpretation of data, and manuscript drafting. Fatema Saber participated in clinical assessment, data acquisition, literature review, and manuscript revision. Marwa Mahdy contributed to methodology development, interpretation of results, supervision of the study process, and critical revision of the manuscript. All authors read and approved the final version of the manuscript.
The authors declared that there were no conflicts of interest regarding the publication of this study.
Confidentiality of Data
All collected data were kept confidential and used only for scientific research purposes. Participants’ identities were anonymized using coded numbers instead of personal identifiers. Access to study data was restricted to the research team only.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was self-funded by the authors.
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Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
