DMC dermatologist Tony Downs on the real world psycho-social effects of psoriasis

DMC dermatologist Tony Downs on the real world psycho-social effects of psoriasis

Psoriasis is a common chronic skin condition that affects an estimated 1.3% to 2.6% of people in the UK.

Although primarily characterised by dermatological symptoms, the disease can also have a significant impact on psychological and emotional well being, with depression and other effects that can become more pronounced with increased disease severity. In addition, there is evidence of a higher risk of sexual dysfunction in patients with psoriasis compared to the general population.

Although there are some new therapies used to treat the condition and improve quality of life, they are expensive and many experts believe psoriasis is not given enough priority in the NHS.

Dr Tony Downs is DMC’s lead dermatology consultant specialising in medical laser procedures, skin cancer diagnosis and management as well as general dermatology conditions including eczema (atopic dermatitis), allergies, acne, and psoriasis.

Together with researchers from several NHS trusts including London’s Whipps Cross, The Royal Free and Royal Devon & Exeter Dr Downs recently conducted research into the benefits of using adalimumab, an immunosuppressive medicine prescribed for psoriasis as well as rheumatoid arthritis, ankylosing spondylitis (usually inflammation of the spine), axial spondyloarthritis, psoriatic arthritis, Crohn’s disease and ulcerative colitis.

Adalimumab is a medication that can help to reduce pain and swelling by limiting inflammation.

Due to its effects on the immune system, people who take adalimumab are prone to getting infections. This includes serious infections such as tuberculosis and sepsis, so therefore people who have adalimumab are monitored for infections. Recent research has showed it to be effective overall in treating both the physical and psychological symptoms.

“Psoriasis is well represented in dermatology referrals by GPs,” comments Dr Downs.

“Some patients are held back from accessing treatments because the specialist or GP does not feel that the psoriasis is bad enough. Self-esteem and body image greatly improve with effective treatment. This is a perspective that doctors often forget.”

Positive results with adalimumab treatment for psoriasis

The study into adalimumab was conducted from 2012 to 2014, looking at patients in the dermatology departments of 19 secondary and tertiary care NHS trusts.

Patients were monitored for their Dermatology Life Quality Index (DLQI) measurement for 16 weeks following them being prescribed adalimumab for severe psoriasis.

Improvements in their disease severity were accompanied by significant improvements in psychosocial wellbeing as well as quality of life scores. Contrary to other research which showed slower psychological responses to the medication, compared to physical responses, patients responded equally quickly in both respects. There was also some improvement in the patients’ sexually functioning that researchers said would be likely to improve after longer treatment periods.

What causes psoriasis?

Psoriasis is not an infectious condition in that it cannot be caught by contact from someone who has it, nor by eating by eating food prepared by them or things like sharing the same towel. Like some other skin conditions it is more complex than that, involving an element of environmental triggers – such as stress – as well as genetics and our adaptive immune system.

Even now it is not fully understood by clinicians, although it’s accepted that plaque psoriasis is rooted in the way skin cell renewal gets accelerated by T cells in the body’s immune system (the same cells that react to fighting an infection or healing a wound).

Approximately 30% of people with psoriasis have a family history of the condition.

Additional health concerns

What is not always appreciated is that the skin inflammation from psoriasis is often just the tip of a larger iceberg. The same cell inflammation that causes untoward cell growth can be responsible for other underlying health risks such as cardiovascular disease, diabetes as well as depression – secondary effects or co-morbidities.

These all appear with increased frequency, affecting the patient’s lives, in parallel with the severity of the condition. As a long-term condition accompanied by itching, pain and sometimes difficulty with walking or sleeping it can have a profound effect on a person’s physical and emotional wellbeing.

Research from Kaiser Permanente Medical Center in the US found that 84% of patients with long-term psoriasis avoided sporting activities, 83% felt the need to hide their condition, 74% reported lowered self-confidence, 46% were chronically depressed and 35% felt inhibited in their sexual relationships.


DMC Healthcare is a leading provider of Consultant-led community outpatient clinics for NHS patients in the UK. Our mission is to ensure all of our patients have access to localised, specialist quality healthcare in their community. We are continually assessing and redesigning our clinical pathways based on local NHS demand, in addition to primary care and specialist community care, our services now include clinical pharmacists in GP practices, minor surgery and dermatology clinics, specialist radiology reporting, reducing outpatient backlogs and GP training and education.

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