Chronic disease influences over 40 major life‐changing decisions (<scp>MLCD</scp>s): a qualitative study in dermatology and general medicine

Bhatti, Zaheer Uddin; Finlay, A.Y.; Bolton, Charlotte E.; George, L.; Halcox, Julian; Jones, Stephanie; Ketchell, R.I.; Moore, Richard H.; Salek, Mir-saeed

doi:10.1111/jdv.12289

Cited by 20 publications

(21 citation statements)

References 30 publications

(46 reference statements)

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“…(150) Furthermore, psoriasis influences pivotal life decisions, such as choice of partner, career and residence. (151) The lives of the patients family members or partners might also be widely disrupted, which should be taken into account when evaluating overall disease burden. (152) [H2] Measurement Quantifying the effect of psoriasis on QoL is essential, as it informs therapeutic decisions (including decisions on therapy initiations and treatment goals), highlights the aspects of the disease that are most important to the patient and helps assess and communicate patient satisfaction.…”

Section: [H1] Quality Of Lifementioning

confidence: 99%

Psoriasis

Greb

Goldminz

Elder

et al. 2016

Nat Rev Dis Primers

731

601

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Psoriasis is a chronic, immune-mediated disorder with cutaneous and systemic manifestations and substantial negative effects on patient quality of life. Psoriasis has a strong, albeit polygenic, genetic basis. Whereas approximately half of the accountable genetic effect of psoriasis maps to the major histocompatibility complex, >70 other loci have been identified, many of which implicate nuclear factor-κB, interferon signalling and the IL-23-IL-23 receptor axis. Psoriasis pathophysiology is characterized by abnormal keratinocyte proliferation and immune cell infiltration in the dermis and epidermis involving the innate and adaptive immune systems, with important roles for dendritic cells and T cells, among other cells. Frequent comorbidities are rheumatological and cardiovascular in nature, in particular, psoriatic arthritis. Current treatments for psoriasis include topical agents, photo-based therapies, traditional systemic drugs and biologic agents. Treatments can be used in combination or as monotherapy. Biologic therapies that target specific disease mediators have become a mainstay in the treatment of moderate-to-severe disease, whereas advances in the treatment of mild-to-moderate disease have been limited.

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Section: [H1] Quality Of Lifementioning

confidence: 99%

Psoriasis

Greb

Goldminz

Elder

et al. 2016

Nat Rev Dis Primers

731

601

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“…66% of patients report that the disease had influenced their choices on professional career, 58% choices of work, 52% choices in personal relationships, 44% in the academic area, 22% in the decision to have children, and 20% in early retirement due to illness. 15 In fact, psoriasis is an inflammatory disease mediated by T lymphocytes, with Th1 and Th17 profiles, and dendritic cells, which are activated and increased in the skin lesions. These cells seem to migrate to the skin and release inflammatory cytokines such as interleukins 1 and 6 (IL-1, IL-6) and tumor necrosis factor alpha (TNF-α), which promote inflammation and proliferation of keratinocytes.…”

Section: Psychophysiologic Disordersmentioning

confidence: 99%

Psychodermatological mechanisms of psoriasis

Torales

Echeverría

Barrios

et al. 2020

Dermatologic Therapy

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Psoriasis is a chronic disease, mediated by the human immune system, based on a polygenic vulnerability, with cutaneous and systemic manifestations and substantial negative effects on the quality of life of patients. The physical and psychological impacts of psoriasis affect all areas of patient's functioning. Likewise, the prevalence of depression and anxiety in patients with psoriasis is significantly higher than that in the general population, and the quality of life is lower when compared to patients with different dermatological conditions. Both anxiety and depression may increase the clinical severity of psoriasis. Although psychiatric disorders in patients with psoriasis may be secondary to the stress due to the shame and social anxiety related to the skin lesions, the high rate of comorbidity has led to hypothesize that there may be common pathophysiological (psychodermatological) mechanisms involved. Inflammation is a key factor, since alterations in inflammatory modulators such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system have been described. This narrative review of the literature highlights the psychodermatological aspects of the etiopathogenesis of psoriasis as well as the impact of illness on patients' personal identity, functioning, and professional, social, and family areas.

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“…In general, patients are exposed to excessive uncertainty regarding their future in terms of longevity and HRQOL, that hampers planning, achieving life goals and influence major life changing decisions. 9 Openly discussing patients' subjective expectations for the future is considered a key role in the management of a lifelong condition and might help to prevent unrealistic expectations that lead to dissatisfaction, dispraising treatment benefits and eventually compliance decrease. 10 This explorative questionnaire survey aims to evaluate adult moderate to severe psoriasis patients' subjective life expectancy (LE) and expected HRQOL for 6 months ahead and for future ages of 60, 70, 80 and 90 respectively.…”

Section: Introductionmentioning

confidence: 99%

“…Future disease course of psoriasis is unpredictable and varies by individual. In general, patients are exposed to excessive uncertainty regarding their future in terms of longevity and HRQOL, that hampers planning, achieving life goals and influence major life changing decisions . Openly discussing patients' subjective expectations for the future is considered a key role in the management of a lifelong condition and might help to prevent unrealistic expectations that lead to dissatisfaction, dispraising treatment benefits and eventually compliance decrease …”

Section: Introductionmentioning

confidence: 99%