Living with Psoriasis: Managing the Life Impact of Psoriasis – Practical Tips to Use in Consultation

Psoriasis can affect every aspect of life – relationships, social life, lifestyle and work and is associated with increased levels of depression and anxiety. Understanding the beliefs, behaviours and emotions of people with psoriasis is essential to formulating effective and appropriate management plans with patients.

Psychological factors in people with psoriasis, such as alexithymia, anticipation of harm and stigma together with time constraints in clinic and skin-focused consultations, can lead to distress and life-impact going un-recognised and untreated. There is some evidence that treating distress can have a positive impact on the severity of psoriasis, and that distress in the form of worry is a major determinant of the outcome of treatment.

Screening for quality of life impact and distress in clinic using relevant questionnaires is a useful tool to identify patients in need of further support, and also provides a trigger to initiate discussion. A patient-centred consultation with setting of agendas for patient and clinician is an efficient way of targeting consultations. Questioning style in clinic is key to eliciting relevant responses which guide treatment decisions and inform treatment goals. Setting of patient-derived treatment goals and step-by-step minitargeted approach to reaching the final goal ensures response to treatment is accompanied by improved life-impact.

Communicating measures of distress, quality of life and patient-derived treatment goals to general practitioners provides an educational tool and will raise the standard of care for people with psoriasis.

Keywords: Alcohol, Alexithymia, Anti-depressant, Anxiety, Beliefs, Cognitivebehaviour- therapy, Consultation, Coping, Depression, Distress, Hypnosis, Lifeimpact, Lifestyle, Obesity, Psoriasis, Psychology, Shame, Smoking, Stigma, Suicide.