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What can be learned from physiopathological studies for patient information purposes?

The plethora of triggering events, of physiopathological pathways and of clinical manifestations turns attention from the disease to the patient, who finally realizes his or her own psoriasis.

The patient must be made aware that psoriasis is not contagious, that it does not put life at risk, that it is an excessive skin reaction—often genetically programmed—to environmental factors which are important to identify. Psoriasis can reveal itself at any time of life. Whatever the situation, it will be possible to treat it, to relieve it, but no definitive cure can be promised. When explaining to a patient that there is no cure, one needs to be mindful that he will generally understand that he cannot be treated— which is something very different though. Equally, the patient must realize that psoriasis is “the skin regenerating too quickly” and that any drug, with its very different mechanisms, will only slow down this cutaneous regeneration. That is why, if the treatment is halted as soon as the skin has regained its normal appearance, the patient risks a very rapid relapse, or even a rebound. These explanations will allow the patient to understand that the fundamental is to carry on treatments, even once the skin appears to have become normal again, in order to give the skin’s natural anti-inflammatory mechanisms time to re-establish themselves.

The acceleration in epidermal regeneration caused by various attacks and, more particularly, by scratching, must be properly understood by the patient, given the impossibility of getting rid of a psoriasis plaque if it is regularly scratched. Finally, the patient must understand that although psoriasis is not endangering his life, it may be impairing his quality of life, therein lying the gravity of the illness. He must therefore learn, step by step, with the help of his dermatologist and GP, to manage all the aspects of his way of life leading to psoriasis flares on his hyperreactive skin. He must understand that, beyond the discomfort engendered by the disease and its treatment, the aim is to succeed in finding a better quality of life.

[|I very much enjoyed patient information issues, as we have for too long treated psoriasis as a trivial disorder. As mentioned by Professor Dubertret in his initial paragraphs at the end of his historical overview, time needs to be spent with each and every patient utilizing literature from patient organizations, eg National Psoriasis Foundation and similar national foundations, to educate patients. Psoriasis being a lifelong disease requires time and patience from physicians, which in the 21st century is frequently not readily available.|auteur215]

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