Recently published online in the Journal of Cutaneous Medicine and Surgery (JCMS), SKIN is the largest survey of its kind in Canada and contributes to a growing body of data regarding the burden of psoriasis in countries around the world.
"Psoriasis negatively impacts people's lives in more ways than one. Patients can experience physical difficulties due to pain caused by plaques and itchy skin, as well as emotional challenges and greater social issues," says Dr.Kirk Barber, dermatologist, Calgary, Alberta. "With the publication of the SKIN data, we now have a better understanding of the effects psoriasis has on Canadians' quality of life and the need for effective treatment and better management of the disease."
The SKIN survey was conducted in partnership with the Canadian Skin Patient Alliance (CSPA), a coalition that provides psoriasis education and information to physicians, patients and researchers. Before SKIN, published evidence about the effects of psoriasis was lacking in Canada and these results provide a Canadian benchmark and offer important insight into treatment patterns.
"The goal of the CSPA is to raise awareness about psoriasis and other skin diseases and to ensure patients and physicians are well-informed about the effects and optimal treatment. The results of SKIN add a new dimension to the information available to us and we look forward to using the data to continue to educate Canadians," says Christine Jackson, Executive Director, Canadian Skin Patient Alliance and co-author of the SKIN publication.
Gender Differences: Female Vs. Male Psoriasis Sufferers
The SKIN study population was predominantly female (66 per cent). Female respondents ranked their disease as a more serious problem than did males and they were significantly more likely than males to say that their psoriasis had been a substantial problem in their everyday life (41 per cent versus 24 per cent). (iv)
Female respondents also reported significantly greater sleep loss in general and greater disability when psoriasis was under poor control.
Under-Diagnosis Of Psoriatic Arthritis In Psoriasis Patients
The SKIN survey reveals that half of all respondents reported that they had developed joint pain or stiffness, but only18 per cent of these respondents had ever received a diagnosis of psoriatic arthritis.
Psoriatic arthritis, a condition linked to psoriasis,(v) causes swelling and pain in and around the joints,(vi) can affect a number of joints including the fingers, wrists, toes, knees, ankles, elbows and shoulder joints, the spine and joints in the lower back and can also affect tissues surrounding the joints including tendons and ligaments.(vii) Up to one-third of people with psoriasis develop psoriatic arthritis.(viii)
Respondents reporting no psoriatic arthritis diagnosis indicated that they experienced stiffness in the knees, shoulders and hips (48 per cent)(ix), followed by pain or stiffness in the finger joints (38 per cent)( x ) and toe joints (23 per cent)(xi).
Psoriasis is a noncontagious, lifelong chronic skin disease, which affects approximately one million Canadians. (xii) It can strike at any age and, in severe cases, have enormous physical and psychological effects on patients.
"The symptoms of psoriasis are visible to people, but seeing it doesn't mean they understand what it's like to live with it," says Allan Stordy, who was diagnosed with psoriasis at the age of 29. "Having psoriasis has caused me to feel anxious and stressed and I used to feel ashamed to even go out in public in short sleeves and or short pants. I tried several treatments, but since starting my current medication, my symptoms have disappeared and I've regained my self-confidence."
The most common form of psoriasis, plaque psoriasis, results when skin cells called keratinocytes start overproducing and accumulating on the surface to create plaques, or red patches on the skin, covered with dry, silvery scales. It can affect the head, body, arms, legs, elbows, knees, groin and genitals, palms and the bottoms of feet.(xiii)
Diagnosis And Treatment Of Psoriasis
It is important for patients with psoriasis symptoms to consult a dermatologist for a definitive diagnosis. Doctors generally treat psoriasis based on the severity of the disease, type of psoriasis, and the patient's attitude toward and response to initial treatments.
Treatments for psoriasis include: topical therapies (ointments and creams containing corticosteroids or coal tar); phototherapy (ultraviolet radiation); and systemic therapies (methotrexate or cyclosporine) taken by pill or injection.
Newer biological therapies (Enbrel(R), Remicade(R), Amevive(R), Humira(R) and Stelara(TM)) work on the body's immune system, treating psoriasis symptoms differently than other medications, and are available to treat moderate to severe forms of the disease. As with any medication, there is the potential for side effects with any of these treatments, including increased risk of infection.
About The Skin Survey
The pSoriasis Knowledge IN Canada (SKIN) survey was conducted to provide insight into the current state of psoriasis in Canada, including number of people affected by psoriasis, quality of life and burden of illness. The objective of SKIN was to characterize the natural history of disease in a sample of Canadians with a history of moderate to severe psoriasis and to identify factors that influenced their perception of psoriasis as a problem in their daily lives.
Between April 30 and June 2, 2007, Canadian households were contacted by telephone by an independent market research group, Leger Marketing. Target telephone numbers were identified from a database of contact information built from consumers requesting information about psoriasis management.
In all, a total of 5,093(xiv) Canadian households were contacted. Individuals who indicated that they had been diagnosed with psoriasis or psoriatic arthritis were asked first if they considered themselves informed about psoriasis and second if, at the height of their condition, the affected areas of their skin would have been covered by at least 3-10 palms of their hands. Those who answered in the affirmative were considered to have a history of moderate to severe psoriasis and were eligible to answer the survey.
Five hundred eligible adult Canadians were administered the SKIN survey. Given an assumed Canadian psoriatic population of approximately one million, it is anticipated that this sample size allows for sound and statistically significant results with a 95 per cent confidence interval of +/-4 per cent. SKIN was conducted in partnership with the Canadian Skin Patient Alliance (CSPA) and supported by an unrestricted educational grant from Amgen Canada Inc. and Wyeth Pharmaceuticals.
(1) This data is not included in the published manuscript and is a survey result.
(2) Answering 8, 9 or 10 on a 10-point Likert scale.
(i) Canadian Dermatology Association. Psoriasis. Last Accessed June 17, 2008.
(ii) Journal of Cutaneous Medicine and Surgery. Issue XX. Page 21. Table 3.
(iii) Rapp SR et al. Psoriasis Causes as Much Disability as other Major Medical Diseases J Am Acad Dermatol. 199 Sep;41 (3 pt 1):401-7.
(iv) Leger Gender Data.
(v) Arthritis Society of Canada
(vi) Arthritis Society of Canada
(vii) Arthritis Society of Canada
(viii) Canadian Skin Patient Alliance.
Last accessed August 29, 2008.
(ix) Journal of Cutaneous Medicine and Surgery. Issue XX. Page 10.
( x ) Ibid.
(xii) Canadian Dermatology Association. Psoriasis. Last Accessed June 17, 2008.
(xiv) Journal of Cutaneous Medicine and Surgery, Issue XX.