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Even mild psoriasis a problem for sufferers

(HealthDayNews) -- Many Americans with small areas of psoriasis on their skin report high levels of dissatisfaction with their current treatment and also regard psoriasis as a problem in their daily life.

That's according to a study released in a recent special issue of the Journal of Investigative Dermatology.

The study found that more than 2 percent of American adults (more than 4.5 million people) have been diagnosed with psoriasis. The skin disease occurs when faulty immune system signals cause skin to regenerate every three to four days, instead of the usual 30-day cycle.

This causes extra skin cells to build up on the skin surface. These excess skin cells form red, flaky, scaly lesions that can itch, crack, and bleed. The condition can be extremely painful.

The study was based on results of a survey commissioned by the National psoriasis Foundation. The survey included more than 27,000 Americans aged 18 or older.

"All too often we hear from psoriasis patients who have given up on treatment, and who have given up hope. Psoriasis has such a significant negative impact on lives -- physically, socially, and emotionally -- and yet society often trivializes the disease," Gail M. Zimmerman, president and chief executive officer of the National psoriasis Foundation, said in a prepared statement.

"This study is a powerful reminder that even those patients whose psoriasis is not considered 'severe' by traditional measurements nevertheless deserve and need additional treatment options that will work for them," Zimmerman said.

She noted there are about 40 psoriasis drugs under development or in clinical trials. The recent discovery of several genes implicated in psoriasis is an important research advance.

The National psoriasis Foundation receives major funding from a number of drug manufacturers. (so how impartial is it really??)

 

Psychosocial stress and psoriasis

Psoriasis is a chronic disease that can have substantial psychological and social impact on a patient s life. For the patient, psoriasis can be far more than "just a skin disease."

However, close family members or patient s friends may not understand the disease.

The psychological impact is likely to be heightened when the onset of disease was early in life when the patient was most vulnerable to psychosocial trauma. Psychological problems can arise from the feelings of the patient about his/her appearance, social rejection, guilt, embarrassment for self and family, and emptiness.

There may also be feelings (sometimes with justification) that psoriasis has limited the patient s career success because employers did not understand the nature of the disease. Patients may also deny themselves enjoyment of leisure activities because of embarrassment and fear of rejection, and the disease often makes patients feel unattractive to the opposite sex.

A number of studies have shown that psychological stress is often caused by psoriasis, and can be a factor in "flares" of psoriasis. Conversely, psychological stress can affect the course of the disease as well as contribute to psychological problems such as depression, anxiety, and unfocused anger. The way stress affects the patient varies from individual to individual; the most common manifestations are psychological depression, anxiety, and obsessional behaviours (Gupta MA, Gupta AK. Psycho dermatology: an update. J Am Acad Dermatol 1996; 34:1030-1034).

The way in which stress, depression and anxiety influence the course of psoriasis is not known. Some studies suggest that the influence may be through an effect on the immune system.

Pruritus (itching)a common symptom of psoriasis may correlate with stress as both cause and effect. Pruritus and stress are two-way mechanisms in psoriasis. Chronic pruritus contributes to psychological stress, and psychological stress can exacerbate psoriasis, making it worse or causing it to flare.

The patient who experiences constant itching is understandably stressed. Scratching in response to pruritus will inflame the skin further, causing the psoriasis patches to become thicker and more resistant to treatment. Constant scratching can also be a source of psychological friction with family members e.g., "Can't you stop that constant scratching?"

Psychological stress can make pruritus worse by mechanisms that are not entirely understood. These mechanisms may include activation of itch-inducing neurochemical pathways, variation in skin temperature and blood flow, and sweating (Koblenzer CS. Psychological and psychiatric aspects of itching. In: Bernhard JD (ed.) Itch: Mechanisms and Management of Pruritus. New York: McGraw-Hill; 1994:347-356.).

Pruritus contributes to stress and that stress can lead to pruritus. This cycle can contribute to psychological problems including depression, anxiety, aggressive behaviours, obsessional behaviour, and alcoholism (Gupta MA, Gupta AK. Psycho dermatology: an update. J Am Acad Dermatol 1996; 34:1030-1034.).

The patient with psoriasis should seek help from a dermatologist when psoriasis is complicated by psychosocial difficulties. If psychosocial problems are contributing to the patient s symptoms, the dermatologist should be taken into the patient s confidence (McKenna MB, Stern RS. The outcomes movement and new measures of the severity of psoriasis. J Am Acad Dermatol 1996; 34:534-538). Disease often responds better when there is an effective doctor-patient relationship. In some cases, psychosocial problems may be alleviated when the patient is enrolled in a support group or referred for psychological counselling (Zachariae R,Oster H, Bjerring P, Kragballe K. Effects of psychologic intervention on psoriasis: A preliminary report. J Am Acad Dermatol 1996; 34:1008-1015.). The patient may ask his/her dermatologist to conduct a family counselling session that will help family members to better understand the nature of the disease and the role that family members can play in reducing psychosocial stress.

Source: Psoriasis Net

A recent survey validates the need for an understanding about how psoriasis can impact a patient's social life and emotional and physical well-being. Psoriasis treatment must also address the social implications, not just the physical symptoms.

 

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psoriasis

Psoriasis is a common skin disease that causes raised red skin with thick silvery scales.

vitiligo

Vitiligo is a disorder in which white patches of skin appear on the body

hair loss

Hair loss usually develops gradually and may be patchy or diffuse

acne

Acne is a disorder of the hair follicles and sebaceous oil glands that leads to skin infections

dermatitis

Inflammation of the skin, often a rash, swelling, pain, itching, cracking. Can be caused by an irritant or allergen

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