Psoriasis and its impact on QoL
Psoriasis is an autoimmune disease that leads to raised, red, scaly patches on patients’ skin. Psoriasis commonly appears on the outside of the elbows, knees or scalp but other locations can also be affected. [About Psoriasis. Available at:
The raised, red patches are due to skin cells multiplying up to 10 times faster than normal. When underlying cells reach the skin’s surface and die, the bigger than normal volume results in raised, red patches covered with white scales.
Fingernails and toenails become discoloured, pitted and begin to crumble or detach from the nail bed. The scalp can also develop scales or crust. [Understanding Psoriasis. Available at: www.webmd.com/skin-problems-and-treatments/psoriasis/understanding-psoriasis-basics#1]
There are various types of psoriasis including plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis, nail psoriasis and psoriatic arthritis.
It is important for patients to seek medical advice early because psoriasis can also cause other serious conditions such as diabetes, heart disease and depression.
Causes of psoriasis
Immune system and genetics have major roles in the development of psoriasis. The genes that control the immune system promote inflammation and skin cell proliferation. However, the exact causes of psoriasis are still unknown.
Patients report they have flare ups due to certain triggers such as skin injury, infections—especially streptococcal infection, HIV, certain medications, stress, obesity, smoking, alcohol and hormonal changes. (Table 1)
Impact of psoriasis
Patients diagnosed with psoriasis are likely to have depression and social stigma. A study by Kim et al looking at 114 patients with psoriasis found the dermatology life quality index (DLQI) was higher when patients were diagnosed at a younger age ie, below 24 years. This is because younger patients were more likely to have depression and sleep problems. They were also at a higher risk of recreational drug use and more severe lifetime discrimination in social settings. [Pediatr Dermatol 2015;32(5):656–662]
A high psoriasis area and severity index (PASI) score, which measures disease severity, was significantly linked to reduced treatment satisfaction and work discrimination. Worse lifetime comparative severity predicted poorer health perceptions, weight problems, smoking and more severe discrimination. [Pediatr Dermatol 2015;32(5):656–662]
The study affirms that early onset psoriasis leads to multiple poor outcomes. A higher lifetime DLQI scores among patients who were diagnosed at a younger age show that disease severity influences immediate quality of life (QoL). Hence, the study authors recommended the need to accurately assess the effect of treatments on QoL throughout the disease course with the hope that doing so can alleviate psychological side effects. [Pediatr Dermatol 2015;32(5):656–662]
A study by Owczarek and Jaworski on adult patients with psoriasis showed patients rated their subjective health lower than general QoL. While there were no significant differences between men and women with regard to somatic, psychological and environment functioning, men reported significantly worse quality of social life compared with women (p=0.01). [Postepy Dermatol Alergol 2016;33(2):102–108]
Furthermore, the study also found that a longer recurrence of psoriatic changes is associated with poorer ratings of QoL. In fact, the duration of the last recurrence was significantly negatively related to patients’ perception of quality of social life (r=0.28; p<0.05). [Postepy Dermatol Alergol 2016;33(2):102–108]
The study authors highlighted that health-related QoL should be assessed in addition to evaluating disease severity and effects on functioning domains to help review treatment progress. They noted that chronic diseases influence patients psychosocially as well as clinically, which might have an impact on QoL if the disease prevents them from being satisfied with their everyday functioning.
Overall, key findings of the study include:
· Psoriasis had a negative impact on psychological functioning.
· Somatic functioning was significantly affected by disease severity.
· Environmental and social functioning were negatively affected by increasing disease severity.
Treatment for psoriasis
The type and severity of psoriasis and the area of skin affected determine treatments. Usually, patients are first given a mild treatment such as topical creams. Then, depending on the disease progression and treatment response, they will be given stronger treatments. [Psoriasis – Treatment. Available at: www.nhs.uk/Conditions/Psoriasis/Pages/Treatment.aspx]
Although a wide range of treatments is available, identifying the most effective treatment can be difficult for patients with psoriasis. Patients should be encouraged to provide feedback to their healthcare provider if the treatment is not working or they have side effects that they are unable to tolerate.
Currently, treatment for psoriasis include:
· Topical – creams and ointments applied to the skin
· Phototherapy – the skin is exposed to certain types of ultraviolet light
· Systemic – oral and injectable medications.