More Than Skin Deep: Assessing the Full Impact of Psoriasis Using the Cumulative Life Course Impairment Rating

Moderate-to-severe psoriasis takes a toll on a patient’s overall health beyond its effects on the skin. Most of the available instruments such as quality of life (QOL) tools only give us a snapshot of QOL at a specific moment. As a result, it can be difficult to capture the true impact of this inflammatory skin disease on a patient across their lifespan.

Enter cumulative life course impairment (CLCI).

CLCI assesses the cumulative impairment experienced by patients with psoriasis as it encompasses the physical, psychological, and social effects of psoriasis over a lifetime for a broader picture of how the disease interferes with an individual’s full potential. The accumulated impact will vary from patient to patient depending on factors such as the burden of stigmatization, the presence of concomitant physical and psychological conditions associated with psoriasis, coping mechanisms, and external factors shaped by the individual’s personality.

Physical Burdens

Psoriasis can cause intense itching, pain, and discomfort, leading to sleep disturbances and physical limitations. Psoriasis is also associated with other systemic conditions, such as psoriatic arthritis, which can cause joint pain and swelling, further impairing mobility and overall physical functioning. It is also known to increase risk for cardiovascular disease, diabetes, and fatty liver disease, among others.

Psychological and Emotional Impact

Living with a chronic condition like psoriasis can take a toll on an individual’s mental health. The persistent nature of the disease can lead to feelings of frustration, anxiety, and depression. The visible nature of psoriatic lesions may cause embarrassment, self-consciousness, and a negative body image, leading to decreased self-esteem and confidence. The stigma and misconceptions surrounding psoriasis may result in social isolation, reduced social interactions, and negative self-perception. As a result, individuals with psoriasis may experience higher levels of stress and emotional distress, affecting their overall well-being and quality of life.

Social Implications

The visible nature of the condition may make patients feel reluctant to engage in relationships and social activities, leading to social withdrawal and feelings of loneliness. Discrimination, misunderstanding, and lack of awareness about psoriasis can further exacerbate these challenges. The cumulative impact of psoriasis on social well-being underscores the importance of creating supportive environments and promoting public awareness to reduce stigma and enhance inclusivity.

Conclusion

We currently lack longitudinal studies about CLCI, but this concept makes intuitive sense to many dermatologists who witness the progressive, cumulative, and irreversible impairments associated with inadequate control of psoriasis and its comorbidities. We need more research on the risk factors for CLCI so we can identify patients more vulnerable to the cumulative impact of psoriasis. CLCI provides a new paradigm for assessing the impact of psoriasis on QOL and can drive earlier therapeutic intervention to improve outcomes.