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,"
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
The National psoriasis Foundation receives major funding
from a number of drug manufacturers. (so how impartial is it
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
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;
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
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
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;
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
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
products for the treatment of psoriasis
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