Perspectives on the Management of Plaque Psoriasis - Episode 4
Considerations for the psychological and social impact that plaque psoriasis may have on a patient.
Christopher G. Bunick, MD, PhD: Dr Torok, let me stick with you for 1 more question. I’m going to pose you the question and then I’ll let Dr Lebwohl answer the same question. What about the psychological and social burdens of plaque psoriasis? What have you observed in your patients? How does the physical manifestations of the disease play a role on the psyche and social stigma in your patients? How do you counsel your patients with that?
Mark G. Lebwohl, MD: It’s actually quite debilitating. First of all, the best thing you can do is assure the patient that we can get their skin normal or close to normal fairly quickly. That takes a tremendous pressure off. I’ve spoken about this in forums with patients present, and patients got up and confirmed that. In fact, the patients said, “One of the best things you said to me early on is, ‘I’m going to make you normal.’” I say to patients when they ask if they’re going to be cured. I say, “No. If this is in your genes, unless we change one of your parents, we’re not curing you. But we can treat it so that your skin will look and stay normal.” That takes a tremendous amount of pressure off them.
Richard Langley did a fascinating study many years ago. He took first-year medical students who were starting school and asked them what they thought about psoriasis. By and large, they thought it was a pretty trivial disease. He then had a tattoo of psoriasis put on their elbows and had them walk around with short sleeves for a couple of days. Then he asked them what they thought about it, and suddenly it became a very serious disease. A lot of us can’t appreciate the effect this has on patients.
Very recently, there was an analysis published about the ability of patients with bad psoriasis to hold jobs and the incomes that they earned. Invariably, it was dramatically less than their age- and sex-matched control counterparts. And that shows up in study after study. There’s yet another study in which SF [Short Form]-36 questionnaires, which measure both physical and psychological functioning, were given to patients, and psoriasis performed worse than almost all diseases on physical functioning, including diabetes, stroke, and severe pulmonary and heart diseases. I can’t remember if it was severe pulmonary or congestive heart failure [CHF] that was the only measure that performed worse than psoriasis.
Jashin Wu, MD: CHF was the worst one.
Mark G. Lebwohl, MD: CHF, so it was heart failure. It was actually worse than cancer. On psychological function it was worse than every other disease except for severe depression. It’s a debilitating disease, both from a physical and psychological standpoint.
Christopher G. Bunick, MD, PhD: Thank you for that. Dr Torok, would you like to add anything from your own perspective in treating your patients and what you’ve witnessed with the psychological and social burden?
Helen Torok, MD: As Dr Lebwohl said, I always touch my patients. I want to show them that they’re not lepers. They’re touchable. That helps them feel better. You touch them. You say, “I feel your pain.” My brother had psoriasis and committed suicide because of his psoriasis. It’s close to my heart. I touch them and say, “I will get you better,” and often they’ll start crying because nobody has said that to them before. “I’m going to put you on something that’s going to clear you quickly.” Just like Dr Lebwohl said, “I will clear you quickly.” That’s what they want. I always touch them and say, “We’ll get you better.”
Christopher G. Bunick, MD, PhD: Dr Torok and Dr Lebwohl, those are very powerful messages about how psoriasis affects people at a real level in terms of their self-esteem and how they interact with other people. This is why we as dermatologists love to treat psoriasis, because we want to help patients feel and do better. I thank you all for this first segment. Next up we have a case presentation and we’re going to discuss more of these issues.
Transcript edited for clarity.