Feelings of stigmatization in patients with psoriasis

The concept of stigma, defined as a discrediting mark that sets a person off from others, is used in a systematic, in-depth examination of how 100 adults with psoriasis experience their illness. Information on demographic and illness variables that might predict feelings of being stigmatized were obtained. Through factor analysis of a specially designed questionnaire, six dimensions of the stigma experience were identified: anticipation of rejection, feeling of being flawed, sensitivity to others' attitudes, guilt and shame, secretiveness, and positive attitudes. There was marked variability in the presence and magnitude of these feelings. Different predictors emerged for different dimensions of the stigma experience, the most frequent being age at onset, extent of bleeding, employment status, duration, and rejection experience. Of all the aspects of the illness, bleeding proved the strongest predictor of stigma feelings and of despair, which correlates highly with stigma. Despair and feeling stigmatized may lead to noncompliance with treatment, possibly worsening the status of the psoriasis.     

Quality of life in patients with psoriasis and psoriasis arthritis with a special focus on stigmatization experience

Negative impact of psoriasis and psoriasis arthritis on quality of life is a central consequence of these diseases. Feelings of stigmatization might, for example, already emerge with only small patches of skin being affected. Empirical data indicate that treating dermatologists should address possible negative effects elicited by problematic encounters with the public and in sexual relationships even if the severity of the disease is low, because lesions on invisible parts of the body can already cause serious adverse impairment. Such psychosocial consequences can be reduced by attending a self-help organization and by taking part in an interdisciplinary patient education program led by dermatologists.     

Lifestyle of Nordic people with psoriasis

AIM: The Nordic Quality of Life Study was undertaken to assess the relationship between psoriasis and the quality of life in Nordic countries. The intention was also to determine whether there was a relationship between drinking, smoking, and the use of psychotherapeutic agents on the one hand, and psoriasis severity and quality of life on the other. MATERIALS AND METHODS: A questionnaire was mailed to 11,300 members of the Nordic Psoriasis Associations. Additional psoriasis patients were recruited by dermatologists (387) or admitted to dermatologic wards (385). These patients also underwent a physical examination, and their Psoriasis Area and Severity Index (PASI) was determined. The questionnaire included the Psoriasis Disability Index (PDI), Psoriasis Life Stress Inventory (PLSI), and additional questions on disease severity, treatment, and psoriasis arthritis. It also included questions regarding lifestyle issues, such as smoking, alcohol use, and the use of tranquilizers, antidepressants, and sleeping medications. RESULTS: The response rate for members was 50.2%. Included in the evaluation were 6497 patients. Men drank significantly more beer and liquor than women. The number of beers per day had a weak correlation with the PDI. Wine consumption, however, showed a weak, but significant, negative correlation with both PDI and PLSI. Patients admitted to dermatologic wards smoked more cigarettes and drank less wine than the other two groups. Significant differences were found between countries with regard to total alcohol consumption and cigarette smoking. The number of cigarettes and the use of tranquilizers, sleeping medications, and antidepressants showed small, but significant, positive correlations with psoriasis quality of life measures. CONCLUSIONS: Cigarette smoking and the use of tranquilizers, sleeping medications, and antidepressants are statistically correlated with impaired psoriasis-related quality of life.     

Epidemiology of psoriasis. Review and the German perspective

According to population-based European studies, 2-3% of the population are affected by psoriasis. However, commonly accepted and validated diagnostic criteria are lacking. Psoriasis patients, compared to those with other dermatological disorders, are among those who suffer the highest impact on their quality of life, and this affection is comparable to other common diseases. Several lifestyle factors including alcohol and smoking have been associated with psoriasis. There is also evidence for associations with other diseases including cancer. Treatment of psoriasis engenders considerable costs, which should always be taken into account together with the relevant clinical outcome parameters. Prevention of psoriasis is crucial, as in the case of other common chronic diseases where causative treatments are lacking, but has barely been studied.     

STG does not associate with psoriasis in the Swedish population

Psoriasis is a chronic inflammatory skin disease that is known to have a strong genetic predisposition. Several psoriasis-susceptibility loci have been previously found through genomic scans. Of these, psoriasis-susceptibility region 1 (PSORS1) on chromosome 6p21 remains the most consistently identified region across populations with the highest association with disease. STG is a gene that was previously isolated from rhesus monkey taste buds, and its ortholog in humans was found to be part of the cluster of genes in PSORS1, which is telomeric to HLA-C. Upon characterization of STG, we identified several sequence variants and investigated their association with psoriasis in cases and controls from the Swedish population. None of these STG single-nucleotide polymorphisms were found to be significantly associated with psoriasis. However, HLA-Cw*0602 status was strongly associated with disease. STG expression was investigated in human tissues and found not to be restricted to taste buds, with signals also being detected in skin and tonsils.     

Perceived relationships between severity of psoriasis symptoms,gender, stigmatization and quality of life

Background Psoriasis is a skin disease with negative physical, psychological and social repercussions for those affected, but we still lack knowledge of how somatic and non‐somatic factors directly and indirectly combine to affect patients’ quality of life (QoL). Objectives This study seeks a better understanding of the relations between symptom severity, discomfort, stigmatization, gender and QoL among psoriasis patients. Methods The sample comprised 381 psoriasis patients in inpatient care. Symptom severity and discomfort were measured subjectively with single items. Stigmatization was measured with the Questionnaire on Experience with Skin Complaints. QoL was measured using the Dermatology Life Quality Index (DLQI) and the Short Form‐8 Health Survey (SF‐8). Results Symptom severity was associated with higher discomfort, stigmatization and lower skin‐related QoL. Symptom severity correlated weakly with more general aspects of QoL as measured by the SF‐8. Men and women reported different experiences with discomfort, stigmatization and mental aspects of QoL (SF‐8 mental component summary score). Some stigmatization parameters function as mediating variables between symptom severity and QoL. Conclusions Our findings suggest that the effect of stigmatization on skin‐related QoL is driven by symptom severity and stigmatization combined, whereas its effect on mental health is driven mostly by stigmatization alone. Further, although women and men experience the social impact of psoriasis differently, the effect of stigmatization on QoL is similar for both genders.     

Association of psoriasis with the VEGF gene polymorphism in the northern Polish population

Background Neovascularization plays an important role in pathogenesis of psoriasis and vascular endothelial growth factor (VEGF) seems to be the main angiogenic factor involved in this disease. Published studies which analysed the role of VEGF gene polymorphism in psoriasis were limited and they received controversial results. Objective The aim of our study was to evaluate the association between ?1154 G/A, ?460 T/C and +405 G/C polymorphisms and the psoriasis susceptibility and to determine whether this genetic variation influence levels of VEGF protein expression. Materials and methods One hundred and eighty‐nine patients with psoriasis and 215 ethnically matched controls were genotyped using ARMS‐PCR and PCR‐RFLP methods. VEGF serum levels were assessed in 47 patients and 40 controls using ELISA test. Results We noted that an increased risk of Type I psoriasis is associated with ?1154 G allele (OR = 1.9; P = 0.04), +405 CC (OR = 2.86; P = 0.03) and ?460 TT (OR = 1.56; P = 0.05) genotypes and demonstrated that a significantly increased risk of developing disease is related to presence of haplotype GTC among all patients (OR = 1.97; P = 0.001), patients with Type I (OR = 1.87; P = 0.005) and Type II psoriasis (OR = 2.37, P = 0.01). We have found significantly increased serum levels of VEGF in patients with psoriasis compared with those in healthy controls (P = 0.008). Serum levels of VEGF significantly correlated with PASI: r = 0.72, P < 0.00001. Patients with elevated levels of VEGF in the serum showed more frequently: GC genotype (P = 0.04), C allele (P = 0.02) at the locus +405 and TT genotype (P = 0.03) at the locus ?460. Conclusion Our results strongly support the role of VEGF gene polymorphism in the pathogenesis of psoriasis.     

Experiences of stigmatization play a role in mediating the impact of disease severity on quality of life in psoriasis patients

BACKGROUND: Psoriasis may have a severe impact on patients' quality of life (QOL) in several ways, an impact mediated by the mental or physical difficulties they have to deal with during the course of the disease and the various treatment regimens. In addition, psoriatic patients often suffer from experiences of stigmatization (EOS) related to the disease. OBJECTIVES: This study was designed to test the hypotheses that psoriasis patients report higher levels of stigmatization than a comparison group, and that their EOS play a role in mediating the impact of the severity of psoriasis on their QOL. METHODS: One hundred patients with psoriasis (study group) and 100 patients with mixed skin problems (comparison group) were matched according to age, sex and education. All subjects answered questionnaires on EOS and QOL. A dermatologist diagnosed the diseases and measured severity scores. The Psoriasis Area and Severity Index score was used for psoriasis and a linear severity score for the comparison patients. The mediating effect of EOS was analysed using structural equation modelling (SEM). SEM is a multivariate statistical method used to examine the consistency of a theory relating one group of variables (termed a 'latent construct') to another: in the present study, the relationship between EOS and QOL. RESULTS: Psoriatic patients were found to report significantly higher levels of EOS related to the disease, compared with the comparison group. No significant differences were found regarding QOL or severity of disease. Clinical severity of psoriasis was found to correlate negatively with QOL in psoriasis patients. EOS were found to have a complete mediating effect for the severity of disease on the QOL in patients with psoriasis. This result was not found among the comparison group patients. CONCLUSIONS: The results of this study indicate that psoriasis patients experience higher levels of stigmatization than do other dermatological patients, and that these EOS mediate the association between disease severity and patients' reported low levels of QOL. Treatment of psoriatic patients should consider these results and should include tools for psychosocial intervention.     

Significance of the stigmatization experience of psoriasis patients: a 1-year follow-up of the illness and its psychosocial consequences in men and women

Feelings of stigmatization are an important somatopsychic consequence of psoriasis, affecting the quality of life. It is thus relevant to supplement reliable statements about the detailed changes of stigmatization experience and psoriasis over time. In this study we compared the Psoriasis Area and Severity Index (PASI), the 'self-administered PASI' (SPASI) and the 'Questionnaire on Experience with Skin Complaints' of 166 psoriasis patients (64 women, 102 men) in a 1-year follow-up to assess the relation between these factors over time. The results suggest a more pronounced feeling of discrimination in women with no significant somatic differences between gender at the first measurement. In a prospective evaluation we found a clear proportion of 'discordant' courses of these parameters, mainly in women, indicating a contradictory relation of somatic improvement or deterioration vs subjective experience with skin complaints. All in all, these results show a moderate but significant relevance of skin state for feeling of stigmatization over time only in men, thus suggesting a considerable influence of other psychic variables, probably coping skills, especially in women.     

Associations of IL-2 and IL-4 gene polymorphisms with psoriasis in the Korean population

BACKGROUND: Psoriasis is association with an overexpression of T-helper cell type 1(Th1) cytokines and relative underexpression of Th2 cytokines. The cytokine production is under genetic control, and certain allelic variants of cytokine genes are associated with higher or lower cytokine production in vitro and in vivo. OBJECTIVES: We aimed to evaluate association of cytokine genes polymorphisms with psoriasis in the Korean population. METHODS: We investigated the polymorphisms of IL-2 -330, IL-4 -590, IL-4 receptor +1902, IL-10 -1082 and -819, and IFN-gamma intron 1 in 114 psoriasis patients and 281 healthy normal controls in Korean. RESULTS: IL-2 -330*G and IL-4 -590*C alleles significantly increased in psoriasis patients, especially late-onset group, compared to the control. The combined effect of IL-2 -330*G and IL-4 -590*C showed that the positive combination of IL-2 -330*G and IL-4 -590*C alleles were more significantly associated with the late-onset group of psoriasis patients than the controls. CONCLUSIONS: These results suggest that the genetic polymorphisms of IL-2 and IL-4 genes can be susceptible to psoriasis in Korean, especially late-onset psoriasis group.     

蒙古族寻常性银屑病与HLA-Cw及DRB1位点相关性研究

【摘要】 目的 探讨蒙古族人群寻常性银屑病与HLA-Cw 及DRB1等位基因的相关性,为银屑病病因学研究提供依据。方法 序列特异性引物聚合酶链反应（PCR-SSP）对蒙古族寻常性银屑病患者81例及正常蒙古族100例进行HLA-Cw及DRB1位点的等位基因进行分型。结果 银屑病组HLA- Cw*06,DRB1*07等位基因频率显著高于健康对照组,HLA- Cw*04、DRB1*04等位基因频率显著低于健康对照组（Pc ＜ 0.05或0.01）。在发病年龄 ＜ 40岁银屑病及家族史阴性患者中HLA- Cw*06、DRB1*07等位基因频率显著高于健康对照组,而HLA- Cw*04、DRB1*04显著低于健康对照组（Pc ＜ 0.05）。在发病年龄≥ 40岁的银屑病及家族史阳性患者中只有HLA- Cw*06等位基因频率显著高于健康对照组（Pc ＜ 0.05）。结论 HLA- Cw*06、DRB1*07等位基因可能是内蒙古地区蒙古族人群寻常性银屑病的易感基因。HLA- Cw*04、DRB1*04等位基因可能是内蒙古地区蒙古族人群寻常性银屑病发病的保护因子。HLA- DRB1*07可能是发病年龄 ＜ 40岁的银屑病的易感基因,而HLA- Cw*04、DRB1*04则可能是发病年龄 ＜ 40岁银屑病的保护因子。