الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
Our skin plays an enveloping role in our lives. In addition to
its essential function as barrier in preventing infection and fluid loss,
the skin acts as an organ of sensation, sexuality and social
interaction. Our skin affects our body image and self esteem and also
influences others’ perceptions of us when this organ is disfigured, the
impact on a person’s self-image (Updike, 1972).
Psoriasis is a medical condition that occurs when keratinocytes
proliferate too quickly. Faulty signals in the immune system cause
new keratinocytes to form in days rather than weeks. The body does
not shed these excess skin cells, so they cells pile up on the surface
of the skin and lesions form. Psoriasis is a skin disease that can have
substantial psychological, emotional and social impact on patients
and their families and friends (Gudjonsson and Elder, 2008).
There are five types of psoriasis: Plaque, guttate, pustular,
inverse, and erythrodermic. About 80% of people living with
psoriasis have plaque psoriasis, also called ”psoriasis vulgaris”.
Plaque psoriasis is manifested as thick, scaly skin plaques that may
be white, silvery, or red. It can develop anywhere on the skin. The
most common areas to find plaques are the elbows, knees, lower
back, and scalp (Sampogna et al., 2004).
Psoriasis also can affect the nails. About 50% of people who
develop psoriasis have changes in their fmgemails and/or toenails.
Nail psoriasis can be a sign of psoriatic arthritis. Without treatment,
psoriatic arthritis can progress and become debilitating. Early
treatment can prevent joint deterioration (Sampogna et al., 2004,
2008).
The person’s immune system and genes play key roles. When a
person has psoriasis, the T cells mistakenly trigger a reaction in the
skin cells. This is why psoriasis referred to as a ”T cell-mediated
disease” (Gelfand et aL, 2005).
Psoriasis is a chronic (lifelong) medical condition. For some
people, psoriasis is a nuisance. Others find that it affects every
aspect of their daily life. The unpredictable nature of psoriasis may
be the reason. Some people have frequent flare-ups that occur
weekly or monthly while others have occasional flare-ups (Cal/is et
al., 2009).
When psoriasis flares, it can cause severe itching and pain.
Sometimes the skin cracks and bleeds. When trying to sleep,
cracking and bleeding skin can wake a person frequently and cause
sleep deprivation. A lack of sleep can make it difficult to focus at
school or work Sometimes a flare-up requires a visit to a
dermatologist for additional treatment wasting more time from
school and work (Callis et al., 2009).
These cycles of flare-ups and remissions often lead to feelings
of sadness, despair, embarrassment, guilt and anger as well as low
self-esteem. Depression is more prevalent in people who have
psoriasis than in the general population. (Callis et aL, 2009).
Psoriasis is a disease that can influence (1) how you fell about
yourself, (2) how others feel about you, and (3) how you believe
others feel about you. It my have substantial impact on your
interpersonal relations. The psoriasis patient who is repelled by her
own image in the mirror may project that feeling to others, e.g., ”1
know how they must feel about me because 1 know how 1 feel about
myself’ (Gupta and Gupta, 1997).
Family members and friends can contribute to a healthy self-
image if they understand the facts about psoriasis. Feedback and
support from informed family and friends can be essential to the
maintenance of psychological and emotional health and the ability to
”reject rejection” from those who do not understand the nature of the
disease. The dermatologist can provide ongoing support as a
professional who thoroughly understands the nature of the disease,
including its psychological, emotional and social manifestations
(Gupta and Gupta, 1997).
Stress whether physical, emotional or psychological can be a
trigger for psoriasis. Stress can be an initiating or aggravating factor.
Just the fact of having psoriasis is, in itself, psychologically and
emotionally stressful. Lack of understanding by spouse, parents,
children, other family members, friends, and coworkers can add
another level of stress. A Psoriasis net site visitor described her
overwhelming feeling of rejection when her husband became distant
because he could not bring himself to touch her skin (Y osipovitch et
al.,2000).
Female sexual dysfunction or dissatisfaction is defined as a
loss of interest in sex (low libido) and the inability to become
aroused or to achieve orgasm when participating in sex. Many are
dissatisfied because their partners are uneducated or inattentive and
do not understand female arousal and its anatomical basis. For
others, a medical evaluation uncovers a physiological problem that
impairs sensitivity. The concept of female sexual dysfunction, or
dissatisfaction, remains poorly defined (Britten et aL, 1995).
The clinical definition of the female sexual response cycle
consists of four stages of arousal, marked by physiological and
psychological changes. The first stage is excitement, which can be
triggered by psychological or physical stimulation, and is marked by
emotional changes, and increased heart rate, respiration, and vaginal
swelling and lubrication due to increased blood flow. Sustained
excitement is called the plateau, the second stage. Vaginal swelling,
heart rate, and muscle tension may increase as long as stimulation
continues. The breasts enlarge, the nipples become erect, and the
uterus dips. The third stage is orgasm, which involves synchronized
vaginal, anal, and abdominal muscle contractions, the loss of
involuntary muscle control, and intense pleasure. The final phase,
resolution, involves a rush of blood away from the vagina, shrinking
breasts and nipples, and a reduction in heart rate, respiration, and
blood pressure (De Vries et aL, 1992).
The cause of female sexual dysfunction is poorly defined.
Several factors may impede the sexual response cycle, which
requires physical and psychological stimulation: alcohol, anxiety,
depression, emotional problems, distraction, illness, negative body
perception and stress (De Vries et al., 1992).
Taken together, psoriasis may be associated with sexual
dysfunctions in females due to disfiguring skin lesions which is
reflected on self-image and self esteem