Cumulative life course impairment: identifying patients at risk

Cumulative life course impairment (CLCI) is a multidimensional construct, which reflects the overall increasing burden posed on patients by chronic (dermatological) disease. As such, CLCI can, to date, neither be directly measured nor can the patients' risk for CLCI be assessed by univocally defined screening scales. Presently, patients at risk for CLCI need to be identified by clinical, personal and psychosocial indicators and predictors of CLCI which need to be individually applied. Among those factors, the following are to be considered: (1) clinical disease severity; (2) chronic course of disease; (3) early onset of psoriasis; (4) perception of stigmatization; (5) lack of social support; (6) negative impact on profession; (7) 'negative' mood/personality trait; (8) coping strategy; (9) quality of life; (10) behaviors putting the patient at risk, and (11) comorbidities. Each of these factors requires accurate assessment either by clinical considerations or by specific tools. In particular, apart from other any single objectifiable risk factors, personality and social support of the patient can markedly affect the extent of CLCI and thus modulate the risks.