Cumulative life course impairment: evidence for psoriasis.

Psoriasis is a disease state that may present significant cumulative life course impairment (CLCI). The impact of psoriasis on CLCI can be divided into social factors such as stigmatization, psychological factors such as depression, and physical factors such as pruritis, pain and arthritis. With a bimodal age range at first presentation, psoriasis tends to affect those in the second and fifth decades of life. In accordance with the CLCI model, the age of first presentation may substantially affect an individuals' life course, with younger patients more susceptible to CLCI. Social, psychological, and physical factors also provide protection from CLCI: personality, coping mechanisms, social support, and treatment or therapy may act as positive factors and mitigate these damaging effects. As the time course of most clinical trials encompasses a fraction of a patients' life, the true nature of this impact has not been easily captured. Longitudinal CLCI data in psoriasis is limited and continued life course data is needed.