Burden of disease

Psoriasis continues to have a significant impact on quality of life, health-care resource utilisation, costs and productivity. A US study suggested that despite treatment, many psoriasis patients continue to experience clinical symptoms and impaired functioning (Schaefer et al., 2015).

Find out from Professor Andrew Blauvelt the importance of quality of life for patients with psoriasis.

Patients with more severe psoriasis have a greater reduction in quality of life (QoL) and work productivity (Korman et al., 2016). A study evaluating real-life experiences revealed that patients often suffer in ways not recorded by typical severity measures (Pariser et al., 2015). Patients reported that itching/scratching, flaking/scaling and skin pain had a significant impact on their social and emotional lives (Pariser et al., 2015). 

Furthermore, the visible disfiguration associated with psoriasis, particularly when on exposed areas of the body, leads to a significant psychological impact and reduction in quality of life which can include relationship difficulties, employment problems and low self-esteem as well as avoidance of social situations and isolation (Boehncke & Boehncke, 2014; Cohen et al., 2012). 

Ways in which psoriasis affects quality of life

Depression and anxiety

Psoriasis is strongly associated with depression and anxiety (Dalgard, 2015).

A UK primary care cohort study that assessed psychiatric morbidity and suicidal behaviour among 56,961 patients with psoriasis and 876,919 patients without psoriasis found that patients with psoriasis had higher prevalence ratios (PR) for (Parisi et al., 2019):

  • A history of alcohol misuse 
  • Bipolar disorder 
  • Depression
  • Anxiety disorders
  • Self-harm
  • Psychotropic medication prescription

Adolescence

Many cases of psoriasis begin in adolescence. In addition to the challenges seen in adult psoriasis patients, adolescents are also faced with additional and complex issues inherent to adolescence. It is therefore imperative that dermatologists and primary care physicians assess the psychosocial impact of psoriasis in adolescent patients to better identify the impact of the disease (Gonzalez et al., 2016).

Work absenteeism and lost productivity

A French national survey comparing people with and without psoriasis using an online questionnaire found that:(Claudepierre et al., 2018):

  • Patients with psoriasis being treated with systemic therapies (PsoST) had greater sickness and absenteeism rates than those with psoriasis only (PsO)
    • 48% vs. 31% in the last 12 months, respectively 
  • Sick leave within the previous 12 months was highest in patients with psoriasis and psoriatic arthritis (PsO + PsA) but sickness in both the PsO + PsA group and the PsoST group was significantly higher than the control group
    • 66% vs. 35%, respectively; p<0.05
  • The impact on work productivity, measured by an estimated mean decrease in productivity over the previous 7 days in those with active psoriasis, was significantly higher for those in the PsoST group and the PsO + PsA group compared to the controls
    • 43.3% and 57.6% vs. 27.9%, respectively (p<0.05 for both)
Impact on absenteeism and work productivity over the past 7 days

Figure 2. Impact on absenteeism and work productivity over the past 7 days (Claudepierre et al., 2018).
a, active psoriasis skin lesions; b, active psoriasis skin lesions and/or psoriatic arthritis; * significantly higher compared to controls (p<0.05); ** significantly lower compared to controls (p<0.05).

Mortality

A 12-study systematic review and meta-analysis found the following pooled relative risks (RR) for all-cause mortality (Dhana et al., 2019):

  • 1.13 (95% CI 1.09–1.16) in mild psoriasis 
  • 1.52 (95% CI 1.35–1.71) in severe psoriasis

The pooled RRs for cardiovascular mortality were

  • 1.05 (95% CI 0.92–1.20) in mild psoriasis 
  • 1.38 (95% CI 1.09–1.74) in severe psoriasis

For noncardiovascular causes, mortality risk from liver disease, kidney disease, and infection was significantly increased in psoriasis, regardless of disease severity. There was also a significantly increased mortality risk associated with neoplasms in severe psoriasis patients and chronic lower respiratory disease in all and mild psoriasis patients (Dhana et al., 2019). 

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