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With more than 10 million Canadians affected by moderate to severe skin conditions, a new Canadian survey sheds light on how just one of many debilitating conditions — plaque psoriasis — has a tremendous psychological and social impact on patients that lead to diminished self-esteem, embarrassment and depression. Results also reveal an overall low satisfaction with current treatments, which according to the Canadian Skin Patient Alliance (CSPA), makes a bad situation worse.

This October, which is also Psoriasis Awareness Month, the CSPA is encouraging all Canadians to learn more about common skin conditions, such as psoriasis, rosacea, vitiligo, acne and eczema, and to break down internal prejudices about people with these visible skin conditions.

"These conditions often have an impact that go far beyond what you see on the surface," said Christine Jackson, executive director, Canadian Skin Patient Alliance. "With greater understanding and general acceptance, Canadians can help skin patients better manage the emotional effects of living with a skin disorder. It's unfortunate, but many people in our society don't realize the degree to which their prejudiced notions impact the quality of life of skin patients. Canadians need to understand it's not just the disease that causes a patient to feel depressed, but it's also the public's reaction that amplifies that emotional impact."

"Psoriasis can have a huge impact on self-perception, self-esteem, and our interactions with others," said Dr. Kim Papp, President of the Dermatology Association of Ontario, President of Probity Medical Research, Waterloo, Ontario and author of a recent psoriasis quality of life survey. "Living with a chronic skin condition can make one feel like a social outcast. What we sometimes forget, is that social withdrawal often leads to other mal-adaptive behaviours: alcohol use and depression, both of which are far more common in people suffering with psoriasis."

Canadian survey sheds light on problem

Psoriasis is an inflammatory disease in which skin cells replicate at an extremely rapid rate, causing raised, red lesions covered with a build up of dead skin cells. A National Survey to Evaluate the Impact of Psoriasis Among Canadian Patients, conducted by three prominent Canadian dermatologists, concludes that moderate to severe psoriasis significantly impairs the quality of life of patients. The survey of 514 moderate to severe plaque psoriasis sufferers finds that the majority (52 to 66 per cent) report feelings of self-consciousness, embarrassment, frustrations and unattractiveness, not to mention the inconvenience that living with psoriasis brings.

This survey was supported by Ortho Biotech.

Additional survey findings include, 21 per cent report that they experienced depression, 27 per cent feel ashamed and 71 per cent of psoriasis patients report that they "suffer in silence" as a result of their disease. Patients with very severe cases of psoriasis admit to resorting to consuming alcohol (22 per cent) and smoking (20 per cent) to cope with their condition. Less than one per cent of the patients surveyed report positive feelings of calmness, optimism or happiness.

According to the Guidelines of Care for the Management of Psoriasis and Psoriatic Arthritis, published in the May 2008 Journal of American Academy of Dermatology, as many as 60 per cent of psoriasis patients experience depression and in severe cases, some patients will contemplate suicide.

"After being diagnosed with psoriasis I became severely depressed," said Allan Stordy, a sufferer of psoriasis for 20 years. "At age 29 I discovered a small spot on my scalp. I was devastated to learn that it was psoriasis." Within a matter of months Stordy's condition developed in other parts of his body changing his life forever. "Clothing helps to cover most of my lesions but they don't protect me from the shame and embarrassment that has become part of daily life," continued Stordy. "I even find it difficult to participate in public activities with family or friends. Because of this, the psychosocial impact of my skin disease is huge."

The CSPA also wants to send a message to patients letting them know they don't have to cope with the physical and psychosocial impact of their disease alone.

"It's important that skin patients struggling with the psychological impact feel encouraged to speak to health care professionals, engage in patient support groups and seek out available therapies," continued Jackson. "For some skin conditions, like psoriasis, new targeted therapies are available to help patients manage the physical and thereby emotional affects of their condition."

Impact of other common skin diseases on quality of life

Beyond psoriasis, there are other common skin diseases that impact a patient's quality of life.

• For rosacea sufferers, noticeable facial skin lesions can have a profound effect on quality of life. In a National Rosacea Society survey of rosacea patients, 94 per cent of severe patients said rosacea damaged their self-confidence. More than 69 per cent of the total survey respondents said they had experienced embarrassment, 65 per cent reported feelings of frustration and 41 per cent experienced anxiety over their condition. Thirty-five per cent said they had felt helpless; 25 per cent suffered depression; and 18 per cent felt isolated as a result of rosacea.

• Vitiligo is a skin condition in which the skin loses melanin, and irregularly shaped white patches appear on different parts of the body. Vitiligo does not impact overall physical health — the main impact is psychological and emotional and includes embarrassment, depression, anxiety and suicidal thoughts. A recent survey investigating the quality of life of 181 vitiligo patients published in the 2008 British Journal of Dermatology reported patients experienced the following quality of life problems "often" or "all the time": 60 per cent worry of the disease getting worse, 37 per cent experience anger, 34 per cent experience embarrassment, 31 per cent feel depressed, 28 per cent feel that their social life is affected, and 28 per cent feel shameful.

• The redness and flaking of eczema often causes high degrees of self-consciousness, and social withdrawal. Sleep disruption is common in 80 per cent of patients, with 60 per cent reporting that the condition affects their daily activities. Lack of quality sleep (due to itching) can have severe repercussions, reducing a person's ability to function well mentally, affecting performance at work and at school.

• Experience with serious acne can have lasting psychological effects (particularly if it has resulted in scarring), such as decreased self-confidence and self-esteem issues, which can lead to social withdrawal. Clinical depression, social phobia, and certain anxiety disorders have been associated with acne. In fact, acne patients report greater levels of anxiety and depression than other medical populations, including cancer patients and other dermatology patients (with the exception of psoriasis).

"Although these chronic skin conditions cannot be cured, the good news is with proper treatment many Canadians can usually effectively manage their skin disorder while lessening its psychological and social impact," said Dr. Harvey Lui, Professor and Head, Department of Dermatology and Skin Science, University of British Columbia. "There are a variety of treatment options available for many skin disorders as well as ongoing research into novel therapies. If a patient has had an unsuccessful experience, they should talk to their doctor. The role of your dermatologist is to help find a treatment that works for you and support your overall health and well-being."

For more information about skin conditions and available support for patients with skin conditions visit www.skinpatientalliance.ca.