Psychosocial Impact of Psoriasis: A Review for Dermatology Residents
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.
Comment
The psychosocial burden of psoriasis penetrates many facets of patient lives. Psoriasis can invoke feelings of shame and embarrassment that are worsened by the public’s misconceptions about psoriasis, resulting in serious mental health issues that can cause even greater disability. Depression and anxiety are prevalent in patients with psoriasis. The characteristic symptoms of pain and pruritus along with psychiatric comorbidities can have an underestimated impact on daily activities, including employment, interpersonal relationships, and sexual function. Such dysfunctions have serious implications toward wages, professional advancement, social support, and overall QOL.
Dermatology providers play an important role in screening for these problems through validated questionnaires and identifying risks. Simple screening questions such as the PHQ-9 can be beneficial and feasible during dermatology visits. Screening for PsA can help patients avoid problems at work. Sexual dysfunction is a sensitive topic; however, providers can use a 1-question screen from valid questionnaires and inquire about the location of lesions as opportunities to address this issue.
Interventions lead to better disease control, which concurrently improves overall QOL. These interventions depend on both patient adherence and a physician’s commitment to finding an optimal treatment regimen for each individual. Medical management; coordinating care; developing treatment plans with psychiatry, rheumatology, and primary care providers; and psychological counseling and services may be necessary and beneficial (Table). Offering accessible resources such as the NPF website helps patients access information outside the clinic when it is not feasible to address all these concerns in a single visit. Psoriasis requires more than just medical management; it requires dermatology providers to use a multidisciplinary approach to address the psychosocial aspects of the disease.
,
Conclusion
The psychosocial burden of psoriasis is immense. Stigma, public misconception, mental health concerns, and occupational and interpersonal difficulty are the basis of disease burden. Providers play a vital role in assessing the effect psoriasis has on different areas of patients’ lives and providing appropriate interventions and resources to reduce disease burden.
