Cumulative life course impairment in psoriasis: patient perception of disease-related impairment throughout the life course

Abstract

Psoriasis is associated with significant physical, psychological, social and economic burden, the cumulative effect of which may result in failure to achieve 'full life potential' in some patients, termed 'cumulative life course impairment' (CLCI). In this concept, the burden of stigmatization, and physical and psychological comorbidities (risk factors for cumulative impairment) and coping strategies and external factors (having potential moderating effects), interact to cause lifetime impairment. Components of CLCI are supported by cross-sectional data; however, the cumulative nature of impairment in patients with psoriasis is not yet established. Nonetheless, CLCI makes intuitive sense to many dermatologists who recognize the cumulative impact of psoriasis on the lives of some patients. This supplement explores the causes and mechanisms of CLCI qualitatively by presenting cases which are representative of typical patients with moderate-to-severe psoriasis. These cases demonstrate the effect of psoriasis in influencing major life-changing decisions and altering the course of patients' lives, preventing patients from attaining their life goals, pursuing their chosen career, gaining a desired educational level, developing social relationships, gaining full pleasure from family life or having children. All these patients believe that their lives would have taken a different course had they not had psoriasis. Additional research to determine how CLCI occurs and to identify the risk factors for cumulative impairment is required. Understanding the key risk factors for CLCI may help physicians identify patients who are more vulnerable to the cumulative impact of psoriasis, resulting in more appropriate treatment decisions earlier in the disease course.

Cumulative Life Course Impairment in Vitiligo

“…While considerable work has been pursued to explore CLCI in patients with psoriasis [36,37], this is not the case for vitiligo. This seems rather odd, as vitiligo is often visible already in the early stages of life [2] and it is known to be linked to psychological difficulties [14].…”

Two Key Concepts in the Life Course Approach in Medicine: Allostatic Load and Cumulative Life Course Impairment

“…All these burdens have been shown to continuously induce negative effects on patients' social environment, behaviors and quality of life [55]. For example, chronic skin conditions have been reported to influence negatively job decisions, relationships, level of education, self-confidence and well-being [56]. Thus, once a chronic medical condition occurs, environmental, social and psychological factors influence illness progression as well as overall life conditions of the patients.…”

Setting Up a Life Course Questionnaire

“…Our questionnaire will be focused on the right part of figure 2. We want to measure the patient perception of disease-related impairment throughout life course [12], so we have to include items concerning the important milestones in life (education, work, income, and marital life), the impact on relationships and social activities, the impact on time, and the emotional outcomes.…”