Psoriasis: is the impairment to a patient’s life cumulative?

Abstract

Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life--relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a 'full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of 'Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case-control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from 'Life Course Epidemiology' to psoriasis research.

Chronic diseases influence major life changing decisions: a new domain in quality of life research

“…This concept results from an interaction between '(a) the burden of stigmatization and physical and psychological co-morbidities and (b) coping strategies and external factors'. 63 The concept of CLCI as described 63 does not specifically address the impact of psoriasis on major life changing decisions. However, if a major life changing decision is influenced by psoriasis, this is likely to contribute to CLCI, 64 and indeed it may be that influences on major life changing decision are of equal or greater importance than stigmatization and coping strategies in contributing to CLCI.…”

Early intervention in psoriasis and immune-mediated inflammatory diseases: A hypothesis paper

“…Early intervention: towards a new treatment paradigm for psoriasis Psoriasis affects both physical and psychological aspects of a patient's life culminating in self-perpetuating social disconnection (4,89). A cardinal aim of treatment in psoriasis is to ameliorate the course of the disease, to prevent relapses, and to improve overall prognosis by reducing severity.…”

“…It is associated with significant impact on all aspects of patients' lives (3). In some patients, the cumulative effect of this impact perpetuates social disconnection and stigmatization (4). Patients with severe psoriasis have been shown to have a greater probability of low income and a lower probability of working as a result of their condition, compared to those with mild disease (5).…”

Management of Psoriasis

“…Psoriasisli bireylerde kaygı, depresyon, özgüven eksikliği, kendini suçlu ve değersiz hissetme, utanma, damgalanma hissi, sosyal izolasyon, cinsel sorunlar ve intihar düşüncesi sıklığı anlamlı biçimde artmıştır (23)(24)(25)(26)42). Psoriasis sık görülmesine karşın, toplumda hastalıkla ilgili bilgi eksikliği ve çarpık algı mevcuttur.…”