Psychosocial Impact of Psoriasis: A Review for Dermatology Residents

Cutis. 2018 November;102(5S):21-25
October 30, 2018|Cutis
Sree S. Kolli, BA;Sima D. Amin, BS;Adrian Pona, MD;Abigail Cline, MD, PhD;Steven R. Feldman, MD, PhD
Author and Disclosure Information

Ms. Kolli; Ms. Amin; and Drs. Pona, Cline, and Feldman are from the Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Feldman also is from the Departments of Pathology and Public Health Sciences.

Ms. Kolli; Ms. Amin; and Drs. Pona and Cline report no conflict of interest. Dr. Feldman is a speaker for Janssen Biotech, Inc, and Taro Pharmaceutical Industries, Ltd. He also is a consultant and speaker for Abbott Laboratories; Galderma Laboratories, LP; Stiefel, a GSK company; and LEO Pharma. He has received grants from Abbott Laboratories; Amgen Inc; Anacor Pharmaceuticals, Inc; Celgene Corporation; Galderma Laboratories, LP; Janssen Biotech, Inc; and Stiefel, a GSK company. He is a consultant for Amgen Inc; Baxter International Inc; Caremark; Eli Lilly and Company; Gerson Lehrman Group; Guidepoint; Hanall Biopharma; Kikaku America International; Merck & Co; Merz Pharma; Mylan; Novartis; Pfizer Inc; Qurient Co, Ltd; Suncare Research Laboratories; and XenoPort, Inc. He is on an advisory board for Pfizer Inc. Dr. Feldman is the founder of and holds stock in Causa Research and holds stock and is majority owner in Medical Quality Enhancement Corporation. He receives royalties from UpToDate and Xlibris.Correspondence: Sree S. Kolli, BA, Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1071 (skolli@wakehealth.edu).

Psoriasis is a chronic inflammatory disease with both a physical and psychosocial burden. To offer strategies for dermatology residents to assess and manage psychosocial aspects of psoriasis, a PubMed search of articles indexed for MEDLINE was performed using the following terms: psoriasis, depression, anxiety, work productivity, sexual functioning, and interpersonal relationships. Selected articles covered the prevalence, assessment, and management of each of the psychosocial domains of psoriasis. Depression is a common comorbidity in psoriasis patients, and the psychosocial burden of psoriasis is immense. Dermatology providers play a vital role in assessing and managing the psychosocial aspects of the disease along with medical management.

Practice Points

  • The psychosocial impact of psoriasis is an important component of the disease burden leading to reduced quality of life.
  • Assessment of psychosocial dysfunction can be done through short questionnaires, asking patients directly about these issues and anticipating these problems in patients who are most vulnerable.
  • Management of psychosocial impact ranges from pharmacological interventions to helpful resources such as the National Psoriasis Foundation website.

The psychosocial impact of psoriasis is a critical component of disease burden. Psoriatic patients have high rates of depression and anxiety, problems at work, and difficulties with interpersonal relationships and intimacy.1 A National Psoriasis Foundation (NPF) survey from 2003 to 2011 reported that psoriasis affects overall emotional well-being in 88% of patients and enjoyment of life in 82% of patients.2

The reasons for psychosocial burden stem from public misconceptions and disease stigma. A survey of 1005 individuals (age range, 16–64 years) about their perceptions of psoriasis revealed that 16.5% believed that psoriasis is contagious and 6.8% believed that psoriasis is related to personal hygiene.3 Fifty percent practiced discriminatory behavior toward psoriatic patients, including reluctance to shake hands (28.8%) and engage in sexual relations/intercourse (44.1%). Sixty-five percent of psoriatic patients felt their appearance is unsightly, and 73% felt self-conscious about having psoriasis.2

The psychosocial burden exists despite medical treatment of the disease. In a cross-sectional study of 1184 psoriatic patients, 70.2% had impaired quality of life (QOL) as measured by the dermatology life quality index (DLQI), even after receiving a 4-week treatment for psoriasis.4 Medical treatment of psoriasis is not enough; providers need to assess overall QOL and provide treatment and resources for these patients in addition to symptomatic management.

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There have been many studies on the psychosocial burden of psoriasis, but few have focused on a dermatology resident’s role in addressing this issue. This article will review psychosocial domains—psychiatric comorbidities and social functioning including occupational functioning, interpersonal relationships, and sexual functioning— and discuss a dermatology resident’s role in assessing and addressing each of these areas.

Methods

A PubMed search of articles indexed for MEDLINE was conducted using the following terms: psoriasis, depression, anxiety, work productivity, sexual functioning, and interpersonal relationships. Selected articles covered prevalence, assessment, and management of each psychosocial domain.