Quality of Life
Psoriasis is a chronic disease that can have devastating effects on patient quality of life due to its recurring manifestations and significant morbidity.1 Approximately 20% of patients have severe disease, covering greater than 5% of their body or affecting body areas that are sensitive, such as the hands, feet, face or genitals. Psoriasis in these areas can be disfiguring and can greatly impair activities of daily living.1 The impact of psoriasis on physical and emotional functioning is comparable with that of other serious medical conditions, including heart disease, lung disease, depression, arthritis, cancer and type 2 diabetes.2,3
A National Psoriasis Foundation (NPF) patient membership survey found that compared with other age groups, patients between the ages of 18 and 34 years old were more likely to report emotional suffering caused by their psoriasis.4 The majority of this subgroup of patients reported similar quality-of-life concerns: 88% were anxious that the disease would worsen; 81% felt embarrassed when others viewed the condition of their skin; 90% were frustrated with the efficacy of their treatments; 75% reported feeling unattractive; and 54% reported depression.4
The severe social ramifications of psoriasis also have a substantial effect on patient quality of life. Fifty-seven percent of the respondents reported that others have thought their condition to be contagious, and 48% stated that their psoriasis had been mistaken by others for a different dermatologic condition or disease, such as poison ivy (24%) and AIDS (9%).4 Furthermore, 40% of patients with severe psoriasis who were interviewed for this NPF survey have not received equal service in various establishments, such as hair salons and barbershops (24%), public pools (19%) and health clubs (11%).4 Activities of daily living commonly affected by psoriasis in the patients studied include: sleeping, sexual activity, using hands, walking, sitting for long periods, standing for long periods and performing job duties.4 The study also found that the psychosocial impact of psoriasis affected patients' interactions at work and with their family or spouse, as well as their ability to start and maintain friendships.4 The NPF study underscores the extremely negative effect of psoriasis on various aspects of patient quality of life.
Depression is more prevalent among patients with psoriasis than in the general population, which may be attributable, at least in part, to the psychosocial morbidity associated with psoriasis.5-7 One study found that 25% of the patients with psoriasis that were examined had previously had suicidal ideation and 1.6% had tried to harm or kill themselves.8 Psoriasis patients with more extensive disease, a mean total body surface area of approximately 50%, have the highest depression scores.7 Suicidal ideation is increased significantly in patients with psoriasis.8 The NPF survey found that 10% of psoriasis patients between the ages of 18 and 34 years contemplated suicide.4 Assessment tools such as the Dermatology Life Quality Index, the Quality of Life 12-item instrument and the Carroll Rating Scale for Depression are essential for a thorough evaluation of the severity and burden of disease in all psoriasis patients.5 Successful treatment of psoriasis may have a significant impact on patients' depression, as was found in a study that examined psoriasis patients who were being treated with the tumor necrosis factor (TNF) inhibitor etanercept. Investigators found that patients' mean score on the Beck Depression Inventory (BDI) significantly increased (improved) after 4 weeks of etanercept treatment, and the improvement continued throughout the 12 weeks of the study.9
In addition to the emotional and physical burden of psoriasis, patients with psoriasis also incur significant health care costs compared with the general population.10 A recent study showed that a significantly greater percentage of patients with psoriasis used health care resources compared with the nonpsoriatic control group (97.7% vs 87.3%, respectively).10 These patients also used significantly more medical resources for any cause, including both urgent and nonurgent care.10 Furthermore, increased severity of psoriasis is positively correlated with higher health care resource utilization and costs.10
The NPF study discussed earlier found that patients with psoriasis experience difficulty obtaining employment.4 Moreover, analysis of data from the National Health and Wellness Survey revealed that psoriasis negatively affects overall work productivity.11 Patients with psoriasis were significantly more likely to have missed work for health-related reasons, had significantly more health-related work productivity impairment and had significantly more impairment in activities other than work compared with individuals without psoriasis.11
- Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826-850.
- de Arruda LH, De Moraes AP. The impact of psoriasis on quality of life. Br J Dermatol. 2001;144(Suppl 58):33-36.
- Rapp SR, Feldman SR, Exum ML, et al. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41(3 Pt 1):401-407.
- Krueger G, Koo J, Lebwohl M, et al. The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol. 2001;137(3):280-284.
- Kim N, Thrash B, Menter A. Comorbidities in psoriasis patients. Semin Cutan Med Surg. 2010;29(1):10-15.
- Esposito M, Saraceno R, Giunta A, et al. An Italian study on psoriasis and depression. Dermatology. 2006;212(2):123-127.
- Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139(5):846-850.
- Rapp SR, Exum ML, Reboussin DM, et al. The physical, psychological and social impact of psoriasis. J Health Psych. 1997;2(4):525-537.
- Tyring S, Gottlieb A, Papp K, et al. Etanercept and clinical outcomes, fatigue, and depression in psoriasis: doubleblind placebo-controlled randomized phase III trial. Lancet. 2006;367(9504):29-35.
- Yu AP, Tang J, Xie J, et al. Economic burden of psoriasis compared to the general population and stratified by disease severity. Curr Med Res Opin. 2009;25(10):2429-2438.
- Wu Y, Mills D, Bala M. Impact of psoriasis on patients' work and productivity: a retrospective, matched casecontrol analysis. Am J Clin Dermatol. 2009;10(6):407-410.
