For the approximately 7.5 million Americans affected by psoriasis, the thick, red, scaly, itchy plaques it causes only scratch the surface when it comes to the overall implications of this disease. Now, ongoing research linking psoriasis to other serious medical conditions and the incredible toll it can take on a person's overall quality of life are shifting the way psoriasis is viewed -- from a common skin disease to a complex systemic condition.
Speaking March 1 at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Alan Menter, MD, FAAD, chair of the Psoriasis Research Unit at Baylor Research Institute in Dallas, addressed the need for psoriasis to be viewed as a serious disease affecting the whole body with significant quality of life issues.
"In the past, psoriasis was viewed primarily as a cosmetic nuisance that was not thought to extend beyond the obvious plaques apparent on the skin," said Dr. Menter. "With the discovery of multiple genes related to psoriasis, a better understanding of the immune system responses involved in this disease, and the frequent associations with other serious diseases, we know that psoriasis is a much more complex disease that demands continual monitoring and evaluation by a dermatologist and, if necessary, other medical professionals to address related health issues."
Link between Psoriasis and Other Serious Medical Conditions
Over the years, multiple studies have found that psoriasis is associated with a number of potentially serious medical conditions, including cardiovascular disease, cancer and lymphoma, obesity and metabolic syndrome (also known as "Syndrome X"), autoimmune diseases (Crohn's disease and diabetes mellitus I and II, for example), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD) and even increased mortality. Dr. Menter explained that the majority of these diseases can have a significant impact on a patient's overall health and affect psoriasis patients in different degrees of severity.
"It is important to note that while we are unsure whether psoriasis causes other diseases or that these other diseases cause psoriasis, the fact that an association exists at all is critically important in treating psoriasis patients," said Dr. Menter.
One recent observational study of 3,236 patients with psoriasis and 2,500 patients without psoriasis who served as the controls concluded that patients with psoriasis experienced an increased incidence of ischemic heart disease (where the blood vessels are blocked leading to the heart), cerebrovascular disease (where the blood vessels are blocked leading to the brain), and peripheral vascular disease (the obstruction of arteries in the arms and legs), and mortality.1
Another study examining the increased risk of mortality in psoriasis patients suggests that patients with severe psoriasis may have shorter life expectancies by an average of three to five years than individuals who are not affected by psoriasis. 2
In addition, other studies have shown that psoriasis patients are more likely to consume excessive amounts of alcohol and cigarettes, both of which can negatively impact a psoriasis patient's health. These detrimental behaviors can further aggravate other conditions associated with psoriasis, such as heart disease and COPD.
Impact on Quality of Life from Psoriasis Cannot be Underestimated
Since psoriasis is a chronic lifelong disease that needs to be controlled with a customized treatment regimen, the constant presence of psoriatic lesions or unexpected flare-ups -- at times when patients least expect it -- can cause a considerable amount of stress and anxiety. In fact, psoriasis has long been known to cause considerable emotional stress for patients, including low self-esteem and feelings of rejection, introspection, weight gain, increased use of alcohol and tobacco, and depression (which in some cases can be severe).
Another study conducted by the National Psoriasis Foundation examining attitudes and beliefs about contagious diseases among the general population of young adults found that approximately one-third (36 percent) of those surveyed were unsure whether psoriasis was contagious. In addition, when asked their attitudes about dating and skin conditions, more than half (62 percent) of the respondents reported that they take the condition of a person's skin into consideration when first asking someone out on a date.
Dr. Menter added that the findings of this survey lend credence to the belief held by many psoriasis patients that their disease can have a negative impact on their personal lives and affect their interpersonal relationships.
"We cannot underestimate the complexity of psoriasis, particularly the psychological impact the disease can have on young people," said Dr. Menter. "Even at a young age, psoriasis can affect a person's relationships at home, work or school, and the disease can contribute to an overall poor body image that can be hard to reverse throughout life."
Dr. Menter added that studies conducted regarding the effect of newer biologic medications, such as adalimumab, etanercept and infliximab, on psychiatric symptoms have shown that psoriasis patients may experience significant improvement in fatigue and other symptoms of depression. The newest biologic agent recently approved by the Food and Drug Administration (FDA), ustekinumab, also has been shown to improve sexual dysfunction in patients with moderate to severe psoriasis up to 10 fold.
"Although psoriasis is an incurable disease, it is controllable in the majority of cases with proper treatment," said Dr. Menter. "Over the past several years, there have been a number of newer therapies introduced that are effective in managing psoriasis, and a patient's dermatologist can determine which therapy would work best to control each patient's disease."
1Archives of Dermatology: Vol 145 (NO. 6), June 2009, Pages 700-703
2Archives of Dermatology: Vol 147 (NO. 12), December 2007, Pages 1,493-1,499.
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