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
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.
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.
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
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.
- 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
- Michalek Iea. Global Report on Psoriasis 2016. Accessed August 2017.
- Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R. Quality of life in patients with psoriasis. Health Qual Life Outcomes. 2006;4:35.
- Møller AH, Erntoft S, Vinding GR, Jemec GBE. A systematic literature review to compare quality of life in psoriasis with other chronic diseases using EQ-5D-derived utility values. Patient Related Outcome Measures. 2015;6:167-177.
- Sharma N, Koranne RV, Singh RK. Psychiatric morbidity in psoriasis and vitiligo: a comparative study. J Dermatol. 2001;28(8):419-423.
- Zieciak T, Rzepa T, Krol J, Zaba R. Stigmatization feelings and depression symptoms in psoriasis patients. Psychiatr Pol. 2017;51(6):1153-1163.
- Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(3):425-440 e422.
- Gowda S, Goldblum OM, McCall WV, Feldman SR. Factors affecting sleep quality in patients with psoriasis. J Am Acad Dermatol. 2010;63(1):114-123.
- Melikoglu M. Sleep Quality and its Association with Disease Severity in Psoriasis. Eurasian J Med. 2017;49(2):124-127.
- Kohatsu ND, Tsai R, Young T, et al. Sleep duration and body mass index in a rural population. Arch Intern Med. 2006;166(16):1701-1705.
- Knutson KL, Ryden AM, Mander BA, Van Cauter E. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med. 2006;166(16):1768-1774.
- King CR, Knutson KL, Rathouz PJ, Sidney S, Liu K, Lauderdale DS. Short sleep duration and incident coronary artery calcification. JAMA. 2008;300(24):2859-2866.
- 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.
- Feldman SR, Malakouti M, Koo JY. Social impact of the burden of psoriasis: effects on patients and practice. Dermatol Online J. 2014;20(8).
- Ghorbanibirgani A, Fallahi-Khoshknab M, Zarea K, Abedi H. The Lived Experience of Psoriasis Patients from Social Stigma and Rejection: A Qualitative Study. Iran Red Crescent Med J. 2016;18(7):e27893.
- Feldman SR, Fleischer AB, Jr., Reboussin DM, et al. The economic impact of psoriasis increases with psoriasis severity. J Am Acad Dermatol. 1997;37(4):564-569.
- Armstrong AW, Schupp C, Wu J, Bebo B. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011. PLoS One. 2012;7(12):e52935.
- Vanderpuye-Orgle J, Zhao Y, Lu J, et al. Evaluating the economic burden of psoriasis in the United States. J Am Acad Dermatol. 2015;72(6):961-967 e965.