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

TLDR

Psoriasis imposes significant physical, psychological, social, and economic burdens that can accumulate into a cumulative life course impairment (CLCI), a failure to reach full life potential, a concept supported by cross‑sectional data but not yet proven cumulative, and one that dermatologists intuitively recognize. The study aims to explore the causes and mechanisms of CLCI through qualitative case presentations and to identify risk factors that could enable clinicians to detect vulnerable patients early and tailor treatment. The authors use qualitative case studies of typical moderate‑to‑severe psoriasis patients to investigate the causes and mechanisms underlying CLCI. The presented cases show that psoriasis can derail major life decisions—such as career, education, relationships, and family life—preventing patients from achieving their goals, and patients report that their lives would have followed a different trajectory without the disease.

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.