Psoriasis is a chronic relapsing inflammatory disease of the skin, which significantly reduces the quality of life of patients. In approx. 2/3 of the cases, the disease is presented as “mild”, while in 1/3 of patients, the disease is manifested more severely. Mild cases with limited skin lesions are not such a big problem, however, it is different in the case of moderate to severe psoriasis, which greatly limit the functioning of social, professional, and even familial relations. Patients require intensification of treatment recommendations and the proper conduct of healing from the leading dermatologist who should provide the patient with a flexible treatment plan for long-term usage of available therapeutic options.
Each patient who has developed psoriasis, requires treatment on an individual basis. The type of treatment depends on many factors, including the form of the disease, its severity, the patient's age, sex, occupation, lifestyle, psychological attitude towards the disease, as well as the course of the current treatment and its effects.
In 6-42% of patients, psoriatic arthritis may develop, which belongs to seronegative spondyloarthropathies. Then, in the clinical picture of the disease, in addition to the typical skin lesions of psoriasis, there is inflammation of the joints (asymmetric inflammation, joint destruction, distortion, pain, physical disability, even leading to permanent disability). The disease then requires the cooperation of dermatologists and rheumatologists.
Based on my observations during the years of working with patients with psoriasis, I know how this disease can adversely affect the quality of life of patients. This has a direct relationship with the stress that accompanies every stage of the disease. The problem is very important, because as many scholars have demonstrated, including Devrimci-Ozguven et al., Psychological stress is associated with the occurrence of lesions in up to 40-80% of patients with psoriasis.
Psoriatic changes on the scalp and other prominently visible places have a greater impact on the patient’s psyche than those of other skin changes, which can easily be concealed.
Patients often doubt whether doctors can actually help them due to many years of different prescriptions of varying topical treatments yielding limiting effects. Thus why patients often present a negative attitude towards treatment and do not want to comply with recommendations. They have doubts. Some stop going to their dermatologist for control visits. Concurrently, they do not have the courage and strength to talk about their needs and left discouraged. Their whole life is subordinated to the disease. The continuous need for lubrication, frequently in a scheme of 2 times per day, has a great impact on the individual’s normal daily functioning, thus, reducing quality of life.
In the proper treatment of patients, which often achieve long periods of remission, it is important in terms of individual cases, but also globally. Therefore, it is essential to promote knowledge about the etiopathogenesis of the disease and its treatment possibilities, both among patients and doctors.
Based on observations, it is a disturbing fact that many patients with moderate to severe psoriasis are frequently treated externally, which creates much disappointment due to the lack of satisfactory results by prescribed therapy. Understanding the proper principles of the therapy of psoriasis by both patients and physicians, and then applying them into daily practice, will allow patients for potential implementation of biological treatments in the future.