Psoriasis 1: Pathogenesis and clinical features of psoriasis

• Published in: The Lancet (British edition) 2007-07, Vol.370 (9583), p.263
• Main Authors: Griffiths, Christopher E M, Jonathan N W N Barker
• Format: Article
• Language: English
• Subjects: Arthritis; Cardiovascular diseases; Chronic obstructive pulmonary disease; Medical treatment; Photodynamic therapy; Psoriasis; Quality of life; Skin diseases; Studies; Swimming pools
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(07)61128-3

If a patient appears to have been cleared of psoriasis by systemic therapy, there is no reliable way to ascertain whether control is absolute other than reducing the dose of, or withdrawing, therapy.\n83 Studies have shown reliably that psoriasis produces a decrease in quality of life at least equal to and often greater than that of conditions such as diabetes, ischaemic heart disease, and chronic obstructive pulmonary disease.84 The dermatology life quality index is a questionnaire used increasingly to assess improvements in quality of life resulting from therapeutic intervention.83 The stress caused by living with psoriasis can manifest as avoidance behaviours; for example, unwillingness to attend local swimming pools for fear of the ignominy of being asked to leave by a member of the public with unwarranted concerns about the contagiousness of the condition. Objective studies have emphasised the role of automatic vigilance86 for threat in patients with psoriasis, and indeed their coping behaviours are similar to those used by patients with cancer or chronic pain.87 Concerns about chronicity of disease and the absence of a cure are an important undercurrent: even patients in whom systemic therapy causes remission maintain high levels of anxiety because of the fear of relapse.88 Psychological sequelae of the disease can impair response to treatment: patients with pathological levels of anxiety are less likely to respond to photochemotherapy.89 Even patients' partners and dose relatives are less attuned to the psychosocial sequelae of the disease than might be expected.90 Doctors experienced in the management of psoriasis remain fairly poor at identifying and subsequently addressing depression and anxiety in their patients.91 An understanding of the psychosocial difficulties encountered by patients with psoriasis and other chronic skin diseases, and how a biopsychosocial model could be used in the management of such conditions, are unmet needs.