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Psoriasis quality of life

by Heather Brannon

Psoriasis - More Than Just a Flake

There is a common misperception that rashes are less serious than other medical conditions. Perhaps this is because few skin diseases are life threatening and therefore the impact on the person who has the rash is minimized. However, this view does not take into account the psychosocial impact of the disease experience.

In the case of psoriasis, medical providers often underestimate the degree to which the disease affects the person's quality of life. The phrase "heartbreak of psoriasis" was not created in a vacuum. It is an accurate description of the life of many people with psoriasis. The impact of psoriasis on a person's quality of life is profound and has been well documented in the medical literature.

Severity of Psoriasis

The severity of psoriasis is determined by the percentage of total body surface area (BSA) that is affected.

Skin problems

The majority of cases of psoriasis affect less than 2% of the body surface.
Mild Psoriasis - Less than 5% of the body surface.

Moderate Psoriasis - 5% to 20% of the body surface, although some experts believe the upper cut-off should be lowered to 10% if the hands or feet are involved.

Moderate-Severe Psoriasis - 20% to 30% of the body surface, or lower if the hands or feet are involved.

Severe Psoriasis - Greater than 30% of the body surface.

Physical Impact of Psoriasis

The rash of psoriasis itself impacts a person's quality of life greatly. In one study, patients considered the general appearance of their skin to be the worst aspect of having psoriasis. In another study itching and scaling were identified as being the worst and second worst thing about having psoriasis. Other symptoms that contribute to a lower quality of life include:

Irritation
Soreness
Pain
Burning sensations
Joint pain
Bleeding

Emotional Impact of Psoriasis

The decrease in quality of life for the person with psoriasis can cause significant stress for that person. People with psoriasis have higher rates of depression, anxiety, and anger, not only during flares, but also during remissions. In one study, 75% of people reported that psoriasis undermined their confidence. A number of people with psoriasis, especially men, use alcohol and smoking to reduce the emotional consequences of psoriasis. Many experts believe that smoking and drinking may actually cause damage that contributes to the onset of psoriasis itself.

Social Impact of Psoriasis

Unfortunately, social rejection is a common feeling experienced by people with psoriasis. One study found that the stress induced in patients by the reaction of others to their psoriasis was the best predictor of disability scores. This highlights the impact of social stressors felt by people with psoriasis. Psoriasis is also associated with a decrease in sexual functioning for a significant number of people. This decrease was attributed to the effects psoriasis had on their appearance. In addition, physical symptoms such as itching, scaling, and pain negatively affect sexual functioning.

Financial Impact of Psoriasis

In the United States, a conservative estimate of the outpatient cost of psoriasis was greater than $4 billion. The financial cost to the patient includes not only medical care, but also time to care for the disease, time away from work, and a decreased quality of life at work.

There is a misperception that rashes are less serious than other diseases. Perhaps ? because few skin diseases are life threatening, therefore the impact on the person with the rash is minimized. However, this view does not take into account the psychosocial impact of the disease.