Abstract

Introduction

Psoriasis is a common, genetically determined, chronic papulosquamous disease of the skin and joint, characterized by the the presence of sharply demacerated, dull-red scaly plaques, particularly on extensor prominence and in the scalp. The disease is enormously variable in duration and extent.

Psoriasis affects 1-2% of general population. Females tend to develop psoriasis earlier than males. Patients with a family history of psoriasis tend to have an earlier age of onset. The sex-ratio is equal.

Aetiology: Psoriasis appears to have a multifactorial aetiology.

Predisposition: Population surveys, twin studies pedigree analgesis and HLA studies suggest genetic basis for psoriasis. It is three times commoner in psoriatic sibships, one of whose parents has the disease.¹

Provocation: Several factors are now accepted as of potential importance. Trauma, infection have been observed to be responsible for psoriatic provocation. There are peaks of incidence at puberty and at menopause suggesting the role of endocrine factors. Metabolic causes e.g. hypocalcaemia following accidental parathyroidectomy has precipitated psoriasis. Drugs like antimalarials, beta-adrenergic blockers sudden withdrawal of corticosteroid therapy, lithium, alcohol seem to aggravate psoriasis. The role of psychogenic factors has been discussed in more detail in the following pages.

Pathogenesis: Hyperplasia and neutrophilic infiltration of the epidermis as well as papillary vascular dilatation and congestion are seen in classic plaque type psoriasis. Accelerated epidermal turnover and definite keratocyte maturation results in visible exfoliation of the skin. Vascular changes lead to erythema whereas dense neutrophilic infiltrate may lead to sterile intraepidermal pustules in pustular psoriasis.

Other skin diseases may coexist or alternate with psoriasis e.g. seborrhoeic dermatitis, eczema, lichen simplex, lichen planus. Arthritis, gout, diabetes mellitus, hypocalcaemia, intestinal disease and malabsorption are also associated with psoriasis.

Complications are uncommon and may include secondary infection, eczematisation, itching, postulation, hepatic or renal failure, arthritis, amyloidosis, tumor formation etc. Psoriasis still remains a chronic and unpredictable disease. The treatment mainly consists of topical bland emolients like white soft paraffin, oral methotrexate, retinoids, cyclosproin, occasionally systemic steroids, and PUVA therapy. The following review of literature throws light on the need for identifying the psychosocial aspects of the disease and plan appropriate interventions which will go a long way in the overall management and outcome of the disease.

In infancy and early childhood, the sensory function of the skin plays critical role in growth and development. It has been shown that human preterm neonates who received tactile and kinesthetic stimulation gained weight more rapidly, were more alert, and exhibit more mature nerurologic reflexes than controls. Even though only 6.5% of patient’s of psoriasis develop their disease before the age of five years, it is important for the physician to ensure that these patients receive adequate cutaneous stimulation from their care-givers, whose intial reaction may be to avoid touching the patient⁰².

Over one third of patients with psoriasis first develop their disease before the age of 20 years. During adolescence, an individual’s self-esteem and body image are largely contingent upon peer approval. Development of cosmetically disfiguring psoriasis, which may be associated with increased self-consciousness and social disapproval, can culminate in serious psychological and body image problems. In some cases the psychological impact of cosmetic disfigurement may also result in academic underachievement.

When psoriasis occurs in later life, the concurrence of other major life changes may alter the patient’s perception of the disease. Such patients may be attempting to regain control over their lives by focusing on aspects of their life that they believe they can control, such as some aspects of their physical appearance.  This may lead to overconcern about the cosmetic impact of the disease. Such psychological issues need to be investigated early in treatment, as it is likely that many patients will not be satisfied with treatment outcome if these issues are not addressed.

Many studies over decades attest to the emotional misery and disruption patients experience in their interpersonal relationships, inner lives and daily activities. Embarrassment and depression, interpersonal anxiety, and difficulty functioning at work, as well as limited opportunities, family frictions, and sexual inhibition may be linked to psoriasis^{03, 04,05}. Compared with men, women have been found to experience greater interference with their social and sex lives, with relations with other women and men, as well as subjective stress and worry in most studies⁰⁶.

It is therefore decided to do an in-depth study of patients of psoriasis and to divulge into their psychological aspects.

Aims and Objectives

1. To study the role of emotional factors in the course of psoriasis.
2. To study the impact of the disease on various psychosocial aspects in patients of psoriasis.