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Severity of Psoriasis Depends on Household Income / Quality of Life

Psoriasis develops when the ordinary life cycle of skin cells accelerates. Skin cells regularly die and flake off in scales — Normally, it takes about a month for new skin cells to move up from the lower layers to the surface. In psoriasis, this process takes only a few days, resulting in a build-up of dead skin cells and formation of thick scales.

Psoriasis starts with the immune system. T cells, a type of white blood cell, usually protect the body against infection and disease by attacking bacteria and viruses. However, when you have psoriasis, your T cells mistakenly attack your skin cells instead. Your body then produces other immune system responses, leading to swelling and rapid production of of skin cells.

Psoriasis is a common skin inflammation (irritation and swelling) characterized by frequent episodes of redness, itching , and thick, dry, silvery scales on the skin.Several factors are thought to aggravate psoriasis. These include stress and excessive alcohol consumption. Individuals with psoriasis may suffer from depression and loss of self-esteem. As such, quality of life is an important factor in evaluating the severity of the disease.As many as 7.5 million people in the United States have psoriasis, according to the National Institutes of Health.

Psoriasis may be aggravated by injury or irritation (such as cuts, burns, rashes, insect bites). It may be severe in immunosuppressed people (like those with AIDS or undergoing chemotherapy for cancer), or those who have other autoimmune disorders (such as rheumatoid arthritis ).

The scales of psoriasis should improve almost immediately after you begin treatment. It may take 2 to 6 weeks for the affected areas of your skin to return to a more normal thickness, and the redness may last several months. While psoriasis will improve, it may not completely go away. Sometimes, certain scaly spots will get better at the same time that other spots get worse.

The disease is chronic, but you may have periods when psoriasis becomes worse alternating with times when it improves or goes into remission.Psoriasis is probably one of the longest known illnesses of humans and simultaneously one of the most misjudged and misunderstood.Individuals with psoriasis may also feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and psychosexual concerns. Psychological distress can lead to significant depression and social isolation.

Psoriasis has been shown to affect health-related quality of life to an extent similar to the effects of other chronic diseases such as depression, myocardial infarction, hypertension, congestive heart failure or type 2 diabetes. Depending on the severity and location of outbreaks, individuals may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care, walking, and sleep. Plaques on hands and feet can prevent individuals from working at certain occupations, playing some sports, and caring for family members or a home. The frequency of medical care is costly and can interfere with an employment or school schedule.

Many Americans with chronic moderate or severe psoriasis receive no treatment or inadequate treatment, a new survey from the National Psoriasis Foundation (NPF) shows.

The poll also revealed a link between severe psoriasis and low income.

Psoriasis is a non-contagious disease in which the immune system causes skin to grow at an accelerated rate.

The surveys, conducted from 2003 to 2005, found that nearly 40 percent of people with chronic moderate or severe psoriasis were receiving no treatment, and that 57 percent of people with severe psoriasis, and 73 percent of those with moderate psoriasis, were receiving topical treatment only. Over half of patients with moderate to severe psoriasis were not receiving treatment that meets American Academy of Dermatology guidelines.

Those guidelines say that people with chronic moderate to severe psoriasis are candidates for phototherapy or systemic therapy, including biologic agents. However, many of those patients were receiving topical treatment alone, according to the survey data.

"Psoriasis is not a cosmetic disease but rather a chronic inflammation condition that can have a profound negative impact on a person's ability to function," Dr. Mark Lebwohl, chairman of the NPF's medical board, said in a prepared statement. "It's important for patients to openly discuss with their dermatologist how the condition may be impacting them, so that together they can determine the most appropriate treatments."

The survey data also revealed a possible association between psoriasis and low income -- 21 percent of people with severe psoriasis had a low household income (less than $30,000 per year), compared to 13 percent for people with mild psoriasis.

"These are the first data to show a relationship between psoriasis severity and household income," Liz Horn, NPF director of research, said in a prepared statement. "Psoriasis is a serious disease that can significantly affect a person's life by interfering with everyday activities, including work."

Maintain good general health to reduce the risk of flare-ups. Obtain adequate rest and exercise, eat a well-balanced diet and avoid stress (see stress management ). Treat respiratory and other infections promptly.

Maintain good skin hygiene to prevent secondary infections. Daily baths or showers are recommended. Avoid harsh scrubbing, which can irritate the skin and cause new outbreaks.Sunlight can help psoriasis, but be careful not to stay in the sun too long. A sunburn can make your psoriasis worse. You should use a sunscreen on the parts of your skin that aren't affected by psoriasis. It's especially important to put sunscreen on your face.