Introduction
Psoriasis is one of the most common immune-mediated dermatological disease with systemic involvement. It affects approximately 0.6% to 4.8% of the world's population with 1.02% of overall incidence in India.1 Stress is described as a predisposing factor in psoriasis. A genetic - environmental interaction has a etiological explanation in psoriasis and stress has been suggested as an important trigger. Psychological distress has also been found to reduce efficacy of treatment in psoriasis and improvement of clinical parameters as a result of psychological interventions adds further evidence for the association between psychological distress and psoriasis.
Materials and Methods
This was a cross sectional study, which was conducted at dermatology OPD in Sree Balaji Medical College and Hospital, Chennai 2021 after ethical committee approval.About 80 patients with psoriasis attending OPD were included in study to whom questionnaire with sixteen questions was asked and data was collected.
Data thus obtained was compiled, tabulated, and statistically summarized using MS Excel and data analysis was done in SPSS 20 version
Results
Total 80 patients with psoriasis above 18 years of age were included in study out of which, 43 were males and 37 were females. A questionnaire was used to assess knowledge about psoriasis in them.
Knowledge about facts of disease: (Table 1)
Around 79% of patients were aware that psoriasis is a lifelong disease, whereas 21% were not aware of it or not sure about the longevity of disease. When asked if psoriasis is contagious, 50% of patients answered that it’s not contagious while 37% believed it to be a contagious disease for whom proper explanation was given.
Of 80 patients, 57 patients (71%) answered that psoriasis is a genetically inherited disease and 65 patients(81%) answered that it can affect any age group. Only 53% of the patients knew the fact that the disease is not curable.
Knowledge about triggering factors: (Table 2)
Of 80 patients, 60(75%) knew that climatic conditions affect the severity of psoriasis. 71% of patients were aware that stress can increase the disease (Figure 1).18(23%) patients were not aware that drugs and injuries can trigger the disease while 13(16%)strongly believed it was not a triggering factor. In about 70% of patients work life and social activities were affected due to disease.(Figure 2)
Knowledge regarding disease process related to psoriasis: (Table 3)
31% of patients didn’t know that fact that psoriasis can affect palms and soles also. Only 35% patients know that psoriasis can occur in nails. 68% of patients accepted that it can be associated with joint pains. Majority of patients, 61% when asked if psoriasis is a skin cancer, they disagreed. Overall, some patients held a few misconceptions regarding the process of disease and its associations.
Knowledge related to treatment of psoriasis: (Table 4)
40% of patients were unaware that phototherapy can be used as a treatment for psoriasis. Around 48% of patient have been using home made remedies for the disease (Figure 3) and 40% of patients didn’t seek any treatment despite severity.
Table 1
Questionnaire- Knowledge about facts of disease
Table 2
Questionnaire- Knowledge about triggering factors
Table 3
Questionnaire- Knowledge regarding disease process related to psoriasis
Discussion
Psoriasis is a chronic inflammatory, stress related dermatological condition, which is well controllable but cannot be cured. It requires long term treatment and good compliance by patient. Knowledge regarding psoriasis helps patients to decide in the treatment and control of their disease. A greater awareness of the nature of their disease may reduce anxiety and stress which are also triggering factors for psoriasis.2
Wahl et al. investigated patient’s knowledge regarding psoriasis before and after patient education in the context of climate therapy. The authors found significant improvement in the knowledge score immediately after the intervention and 3 months after the intervention when compared to the baseline scores.3
Tham SN, Tay YK.4 (1995) conducted a questionnaire based survey to determine the level of knowledge of psoriasis among patients attending the National Skin Centre. Results of the study found that many patients had lack of knowledge about their disease and treatment aspects. They concluded that education is important for overall treatment of psoriatic patients. In our study it has showed that 40% of patients were unaware that phototherapy can be used as a treatment for psoriasis. Around 48% of patient have been using home made remedies for the disease and 40% of patients didn’t seek any treatment for the disease despite severity.
Lora et al. done a study on the efficacy of an educational intervention for patients with psoriasis in improving disease knowledge and attitude towards physicians and systemic treatments. It consisted of information on psoriasis and its treatment. After 6 months, a better knowledge about the disease and a better attitude to treatment were retained. It is clearly evident that a single educational intervention may be helpful in improving psoriasis knowledge and give psychological relief to patients.5 Zachariae et al, reported that in 66% of their patients psoriasis was exacerbated by stress and 35% of them reported that the onset of psoriasis occurred during a time of worry and stress6 which when compared to our study about 71% of patients were aware that stress can increase the psoriasis.
Rakhesh et al. reported that psoriasis sufferers were most likely to feel self conscious, disturbed by shedding of the skin, lived in a continous fear of relapse, and they avoided social interactions,7 in our study it showed that 70% of patients social and work activities were affected with disease.
A study done by Nagarajan et al using knowledge assesment questionnaire demonstrated that many patients with psoriasis do not have adequate knowledge regarding the basic facts, triggering factors, disease process and treatment aspects.8
Conclusion
Psoriasis is a multifactorial disease. Endogenous factors, such as stress, and exogenous factors like climate, drugs, trauma play an important role in psoriasis. Proper awareness regarding disease prognosis, treatment and control of disease to be given for patients with psoriasis. Stress reduction programs help in treating the condition. The results of our study also suggest that an education about psoriasis regarding disease, triggering factors and treatment, may be helpful in improving the knowledge and improves quality of their life.
Article DOI
