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Burden of disease

“The experience of being stigmatised and rejected not only has psychological consequences, but may also lead to behavioural changes”

poorer mental health than those with both minor and serious medical conditions and quite similar to those with psychiatric illnesses (right side of the figure).

The main aspects of quality of life that have to be considered in patients with psoriasis are the following: ● Symptoms: itching, discomfort, burning, stinging, pain, bleeding, irritation

● Emotional aspects: depression, anxiety, suicidal ideation, anger, stress, embarrassment, shame, difficulties in expressing emotions, low self-esteem, low self-confidence

● Social aspects: work/study problems, avoidance of public places and social activities, impact on sexual activity, influence on choice of clothes Most of the psychosocial problems are due to the experience of stigmatisation.


Stigma is a biological or social mark that sets a person apart from others, disrupting their interactions with others. Since psoriatic lesions are visible, patients with psoriasis often experience social stigmatisation and rejection.6

The 6 experience of being stigmatised and

rejected not only has psychological consequences, but may also lead to behavioural changes. People with psoriasis tend to avoid public situations, and even not to choose jobs where public relations are needed. Patients whose psoriasis manifests at an earlier age are more likely to carry feelings of stigmatisation, in particular as to anticipating rejection, feeling sensitive to the opinion of others, feelings of guilt and shame and secretiveness. A child or an adolescent growing up with psoriasis is certainly influenced by the disease when building his/her self-image and self-esteem. Being older seems to be a mitigating force for some aspects of stigma, but not for others. In fact, on the one hand, a person can develop strategies of coping with the disease, but on the other, disfiguring diseases may intrude in daily life and this burden may increase with their duration.2

Associated comorbidities Psoriasis is associated with several physical and psychological comorbidities. Several observational studies have demonstrated that psoriasis is associated not only with psoriatic arthritis, but also with cardiovascular diseases, metabolic syndrome, cancer, chronic obstructive

and large prospective studies will be necessary to clarify the directions of all these associations. However, from a clinical point of view, all the comorbidities must be taken into account in the management of the patients with psoriasis. To summarise, the most frequent comorbidities observed in patients with psoriasis are: ● Physical comorbidities: psoriatic arthritis, dyslipidaemia, hypertension, obesity, diabetes,

pulmonary disease, depression and, recently, osteoporosis. It is important to remember that these are associations, and associations do not prove cause. Whether psoriasis precedes the comorbidities or vice versa is difficult to assess,7

hyperhomocysteinaemia, cardiovascular diseases. Lower evidence for: cancer, chronic obstructive pulmonary disease, osteoporosis

● Psychological disorders: depression, anxiety, alexithymia

The treatment of psoriasis has rapidly improved, thanks to a better

understanding of its pathogenesis and the development of new pharmacotherapy. However, the chronic nature of psoriasis, and the frequent presence of comorbidities, contribute to the

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