Speak Clearly: Perspectives on psoriasis

When you live with a chronic disease such as psoriasis, there is a lot to come to terms with. Your focus initially may be on your physical symptoms, such as your scales. You may worry about the appearance of these, where they are on your body, and if people can see them. These may be your immediate needs and concerns, but it’s important to tune into how these worries may be affecting other areas of your life.

Why? Because conditions such as psoriasis can have an ongoing impact in every part of your life—and life isn’t limited to what physically happens. Your life is filled with career pursuits, hobbies, personal relationships, long-term goals, and so much more. Psoriasis can impact all of these areas. Healthcare professionals have coined a term to describe this idea: Cumulative Life Course Impairment, or CLCI for short.¹

CLCI describes how psoriasis can affect the full course of your life. It’s important to consider your life potential and what you want for your future, because doing this can open more avenues of discussion with your dermatologist. In the end, by sharing all the ways in which psoriasis affects you, it can help you and your dermatologist define a management plan that recognises who you are and what you want to achieve—not simply what your symptoms are.¹

The Framework: What is “Disease Course,” and Why Is it Important?

You have decisions, experiences and paths that intersect throughout your life. Romantic relationships. Career paths. Decisions about having a family. These are all key moments and decisions that can affect your quality of life.

If you are worried about social situations or romantic involvement because of your psoriasis, you may choose to avoid relationships, put off plans to have a family, miss work or choose work that avoids in-person interaction with others. That may keep you from achieving your full potential emotionally or professionally.

The choices you make because of your condition may have life-long effects on your emotional wellbeing, your career, your personal relationships, and so much more.¹

The Evidence: Is There Data About Long-Term Disease Impact?

There are studies that have investigated the long-term impact of certain conditions. For instance, studies have shown positive impacts on life potential based on factors such as a balanced diet, physical activity, education, stable employment, and supportive social networks around you.² Studies have also shown factors with negative effects, including smoking, crime and violence, and drug use.²

Innately, it’s easy to understand how these things influence your life course, your decisions, and your potential. But research also indicates the presence of conditions such as psoriasis have the same lifelong consequences: if you have difficulty adjusting to psoriasis physically and emotionally, you have a greater chance of negative changes that can take away life potential.¹

A key factor to protect against this is having a strong interpersonal network around you⁴: friends, family members, business associates, and health care partners. It’s particularly important to talk about life goals with your doctor. Doing so can help you develop and adjust a management plan to meet your long-term goals, as well as develop a strategy to maintain a network of support.

The Future: Expanding the Discussion with Your Dermatologist

With psoriasis, you can experience ongoing physical symptoms such as itching, discomfort, and even other conditions such as cardiovascular disease, hypertension, hyperlipidemia, diabetes, and depression.⁵ That means you need to cope with the physical aspects and implications of psoriasis, however it’s also important to find ways to cope with the emotional stress, and social stress tied to these physical symptoms.¹

Help is available to guide you in safeguarding your life goals. In fact, just as research shows potential negative impacts if you have difficulty coping, it also shows that shared decision-making on how to manage your condition (with your dermatologist), clear life goals, interventions to support those goals, and access to educational resources/support from others can help you live the life you envision.^1,3,6

Learn how you can start the conversation with your dermatologist about your goals and the best management plan for you here.

References:
1.    Ros S., et al. Cumulative life course impairment: the imprint of psoriasis on the patient's life. Actas Dermosifiliogr. 2014 Mar;105(2):128-34.
2.    Public Health England guidance 2019: Health matters: Prevention—a life course approach. Available at: https://www.gov.uk/government/publications/health-matters-life-course-approach-to-prevention/health-matters-prevention-a-life-course-approach. Accessed December 2020. 
3.    Kimball AB, et al. Psoriasis: Is the impairment to a patient’s life cumulative? J Eur Acad Dermatol Venereol. 2010. doi:10.1111/j.1468-3083.2010.03705.x
4.    Ni C, Chiu MW. Psoriasis and comorbidities: Links and risks. Clinical, cosmetic and investigational dermatology. Published April 17, 2014. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000177/ Accessed July 2022
5.    Ni C, Chiu MW. Psoriasis and comorbidities: Links and risks. Clinical, cosmetic and investigational dermatology. Published April 17, 2014. Accessed July 5, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000177/
6.    Linder, M.D., et al. Psoriasis - The Life Course Approach. Acta Derm Venereol. 2016 Aug 23;96(217):102-8.