title: Psoriasis: is the impairment to a patient's life cumulative?
abstract: Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life--relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a 'full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of 'Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case-control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from 'Life Course Epidemiology' to psoriasis research.
authors.affiliation: Department of Dermatology, Harvard Medical School, Boston, MA, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Kimball
authors.forename: U
authors.initials: U
authors.lastname: Gieler
authors.forename: D
authors.initials: D
authors.lastname: Linder
authors.forename: F
authors.initials: F
authors.lastname: Sampogna
authors.forename: R B
authors.initials: RB
authors.lastname: Warren
authors.forename: M
authors.initials: M
authors.lastname: Augustin
mesh_terms: D000223:Adaptation, Psychological; D006801:Humans; D011565:Psoriasis / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D013240:Stereotyping