Psoriasis: Is the impairment to a patient's life cumulative?

A. B. Kimball, U. Gieler, D. Linder, F. Sampogna, Rb Warren, M. Augustin

Research output: Contribution to journalArticlepeer-review


Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life - relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a 'full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of 'Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case-control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from 'Life Course Epidemiology' to psoriasis research.

Original languageEnglish
Pages (from-to)989-1004
Number of pages16
JournalJournal of the European Academy of Dermatology and Venereology
Issue number9
Publication statusPublished - Sep 2010


  • coping strategies
  • Cumulative Life Course Impairment
  • physical co-morbidities
  • psoriasis
  • psychological co-morbidities
  • stigma

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases


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