Quality of Life in Adults with Psoriasis

How Does Psoriasis Affect Quality of Life?

Psoriasis is a chronic inflammatory skin disorder that affects more than 100 million individuals in the world.1 It is commonly characterized by scaly plaques that can be itchy and painful. If left untreated, this condition can be persistent and is frequently distressing to patients.

By affecting multiple aspects of a patient’s life, psoriasis can have a tremendous negative impact on quality of life. Psoriasis can interfere with activities of daily living, interpersonal relationships, and productivity in the workplace.2

The effects of psoriasis on a patient’s quality of life are reported to be comparable to those of other chronic diseases such as cancer, diabetes, cardiovascular disease, and end-stage renal disease.3

Mental Health

Many individuals with psoriasis also suffer from other psychiatric conditions, such as depression, anxiety, sleep disorders, and sexual dysfunction.4 Having psoriasis lesions on visible areas of the body can make individuals feel self-conscious and adversely affect self-esteem.

Patients with psoriasis may have a distorted view of themselves and may start to think that other people are judging them or talking about them behind their backs, which can cause feelings of stigmatization and may lead to social anxiety or isolation.5 Aside from having increased depression rates, people living with psoriasis also have higher rates of suicidal ideation, suicide attempts, and completed suicide.6 

Having constant discomfort and itch from the skin lesions can contribute to increased levels of stress and a depressive mood. Increased levels of stress can then lead to worsening of psoriasis symptoms, creating a vicious cycle. Patients with psoriasis may also have an associated form of arthritis called psoriatic arthritis that can be painful and disabling, further adding to the psychological burden.

Sleep disturbances

Psoriasis has been shown to have an association with decreased quality of sleep, and more specifically with sleep disorders and insomnia.7 One study found that almost 50% of patients reported that psoriasis negatively affected their sleep at least once a month.8 Factors that were reported to impact sleep in individuals with psoriasis include depression, itchiness, pain, and even obstructive sleep apnea.7

A poor night’s sleep is detrimental to anyone’s health, as it has been associated with a higher risk of developing other serious medical conditions (including obesity, diabetes, and heart disease) and a shortened lifespan.9-11 Sleep is necessary for the recovery of our body on a daily basis, including tissue repair and muscle growth. Therefore, suboptimal sleeping patterns further adds to the decreased quality of life experienced by many patients with psoriasis.

Interpersonal Relationships

Individuals with psoriasis may face various difficulties when it comes to their relationships with other people. Patients with psoriasis may feel like they are being stigmatized by others and, in reality, they often are. Other people in the community may have the misconception that psoriasis is contagious or may judge those with psoriasis differently solely based on appearance. As a result, others may avoid individuals with psoriasis, leaving them feeling rejected and alone.

People living with psoriasis may also have a hard time with intimacy and sexual function, usually related to poor self-esteem or negative self-image.12 Patients with psoriasis commonly avoid sexual intimacy, especially women or patients with psoriatic lesions on their genitals.13 These encounters, or lack thereof, may leave people with psoriasis feeling hurt and ashamed, which can then lead to avoidance of interactions with other people and social isolation.14

Occupational Issues and Economic Burden

Psoriasis can negatively impact productivity in the workplace. Patients with psoriasis are more likely to miss work than their co-workers, with an average of 26 missed work days a year for reasons related to their psoriasis (either because of the condition itself or for efforts to manage it).15 On a survey obtained from patients with psoriasis, it was shown that among those who were unemployed, 92% of them were not working solely due to psoriasis or psoriatic arthritis.16

Furthermore, people suffering from psoriasis report decreased productivity on the days they work, adding to the economic burden of people with psoriasis due to decreased income. One study estimated that the economic burden of patients with psoriasis is $6,422 per year, resulting from total medical costs, costs associated with diminished quality of life and those associated with decreased work productivity.17

Summary

It is evident that psoriasis affects much more than just the skin. It is important that doctors consider all of the areas where psoriasis may make an impact in order to create a management plan that will improve the quality of life of these individuals.

Key Takeaways

  • Psoriasis is a chronic skin condition that can impact many different aspects of a patient’s life
  • Individuals living with psoriasis are more likely to suffer from depression and other mental illnesses, have greater conflicts in their interpersonal relationships, and are more likely to have decreased work productivity
  • Physicians should consider all hardships people with psoriasis face when creating a management plan for patients
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References

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  12. Magin P, Heading G, Adams J, Pond D. Sex and the skin: a qualitative study of patients with acne, psoriasis and atopic eczema. Psychol Health Med. 2010;15(4):454-462.
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