Psoriasis: Beyond Skin Control

A/Prof. Pablo Fernandez-Peñas has just arrived from Hsinchu (Taiwan) and Hong Kong. He was invited to talk about psoriasis, and, in particular, why we have to treat more than the skin, in two IMID (Immune Mediated Inflammatory Diseases) meetings. Gastroenterologists, Rheumatologists and Dermatologists from East Asia attended these meetings sponsored by Abvvie.
Pablo reviewed the impact of psoriasis in the life of patients, and the multiple co-morbidities that make psoriasis a systemic disease. Most people and many physicians don’t know that:
– 81% of patients with psoriasis feel embarrassment and shame
– 75% physically unattractive and/or sexually undesirable
– 54% reported feeling depressed and experiencing social withdrawal
– 26% have experienced in the last month an episode in with people “made a conscious effort not to touch them”
– Up to 5.5% have had suicidal ideation
Patients with psoriasis believe that their lives would have been substantially different without the disease. 66% reported that it influenced their choice of career, 58% their choice of work, 52% their personal relationships, 44% their education. This is has been recognised as the Cumulative Life Course Impairment.
Moreover, up to 30% of patients with psoriasis have arthritis, and there is an increase risk of tobacco use, alcoholism, obesity, hypertension, dyslipidemia, diabetes mellitus… leading to metabolic syndrome and cardiovascular disease, with a 5 year shorter life expectancy.
Treating skin severity is insufficient. Treatment should be decided considering the impact in the life of the patients and the co-morbidities.
Pablo is the consultant in charge of the Severe Psoriasis Clinic, Westmead Hospital, and has a special interest in quality of life.