How does psoriasis impact quality of life, causing symptoms such as pain, discomfort, physical disability, and psychological distress including anxiety and depression?

From the Guidelines

Psoriasis has a profound impact on quality of life, causing significant physical and psychological distress, including pain, discomfort, physical disability, and increased risk of anxiety and depression. This chronic inflammatory skin condition can lead to social stigma and discrimination, making patients feel self-conscious in public settings 1. The physical symptoms of psoriasis include pain, itching, burning, and discomfort, particularly when plaques crack or bleed. In severe cases, psoriasis can affect joint function, causing psoriatic arthritis that limits mobility and daily activities. Psychologically, patients frequently experience anxiety, depression, and poor self-image due to the visible nature of the disease and its unpredictable flares.

Key Factors Affecting Quality of Life

• Severity of psoriasis: Approximately 20% of patients have moderate to severe disease, which can significantly impact quality of life 1
• Location of lesions: Involvement of the hands, feet, facial, or genital regions can interfere significantly with activities of daily life, despite limited body surface area involvement 1
• Individual coping mechanisms: Patients' ability to cope with the disease can vary greatly, affecting their overall quality of life
• Comorbidities: Psoriasis is linked to various comorbidities, including psoriatic arthritis, cardiovascular disease, hypertension, obesity, diabetes, and immune-related ailments, which can further impact quality of life 1

Treatment Approaches

• Topical therapies: corticosteroids, vitamin D analogs, retinoids
• Phototherapy
• Systemic medications: methotrexate, cyclosporine
• Biologics: adalimumab, etanercept, ustekinumab, which target specific immune pathways and can provide significant relief from symptoms and improve quality of life 1

Comprehensive Management

Comprehensive management of psoriasis should address both physical symptoms and psychological well-being through medical treatment and appropriate mental health support. This approach can help alleviate the significant impact of psoriasis on quality of life, reducing morbidity, mortality, and improving overall well-being 1.

From the FDA Drug Label

The principal adverse reactions associated with the use of cyclosporine in patients with psoriasis are renal dysfunction, headache, hypertension, hypertriglyceridemia, hirsutism/hypertrichosis, paresthesia or hyperesthesia, influenza-like symptoms, nausea/vomiting, diarrhea, abdominal discomfort, lethargy, and musculoskeletal or joint pain.

Adverse Events Occurring in 3% or More of Psoriasis Patients in Controlled Clinical Trials Body System*Preferred TermCyclosporine [MODIFIED] (N=182) Sandimmune®1 (N=185) ... Central and Peripheral Nervous System26.4%20.5% Headache15.9%14% Paresthesia7.1%4.8% Musculoskeletal System13.2%8.7% Arthralgia6%1.1% Body as a Whole — General29.1%22.2% Pain4.4%3.2% Psychiatric5%3.8%

Psoriasis can impact quality of life, causing symptoms such as:

• Pain: 4.4% of patients experienced pain
• Discomfort: musculoskeletal or joint pain, abdominal discomfort, and lethargy were reported
• Physical disability: not directly mentioned, but renal dysfunction, hypertension, and hypertriglyceridemia may contribute to physical disability
• Psychological distress:
  • Anxiety: not directly mentioned
  • Depression: not directly mentioned, but psychiatric events (5% of patients) and nervousness (reported in 1% to less than 3% of patients) were reported 2 2

From the Research

Impact of Psoriasis on Quality of Life

• Psoriasis is a chronic skin disorder that affects over 60 million people worldwide, causing both physical and psychological impacts due to visible lesions and associated somatic symptoms 3.
• The disease significantly impacts patients' quality of life, with symptoms such as pain, discomfort, physical disability, and psychological distress, including anxiety and depression 4, 5, 6, 7.

Physical Symptoms

• Psoriasis can cause physical symptoms such as itch intensity, which is negatively correlated with disease acceptance and quality of life 3.
• The disease can also lead to physical disability, with patients experiencing limited mobility and functionality due to skin lesions and joint pain 6, 7.

Psychological Distress

• Psoriasis can cause significant psychological distress, including anxiety and depression, with patients experiencing feelings of embarrassment, self-consciousness, and low self-esteem 4, 5, 6.
• The disease can also impact patients' mental health, with studies showing that patients with untreated psoriasis have similar levels of psychological impairment as patients with other major medical conditions, such as breast cancer and coronary artery disease 4.

Factors Affecting Quality of Life

• Disease severity, itch intensity, and quality of life are negatively correlated with disease acceptance, indicating that lower acceptance is linked to more severe symptoms 3.
• Factors such as female gender, low family income, and primary education level are associated with poor quality of life, while being on systemic therapy is a predictor of better quality of life 6.
• Topical corticosteroids are the mainstay of psoriasis treatment, but biological treatments, such as anti-IL17 and anti-IL23 antagonists, have shown significant improvement in clinical results and safety profile 7.