Unless there are many large patches of psoriasis it is not usual
for the chronic plaque type ofpsoriasis on the body or limbs to
interfere much with work. The individual patches are sometimes sore
but apart from the occasional cosmetic difficulty they should not
cause problems with an occupation. When it affects the flexures,
as it does occasionally, it can cause considerable soreness and
discomfort, and then does interfere with mobility.
Typical widespread psoriasis. There is involvement of between 65 and 70 percent of the body area in this patient.
Sweating is defective
in plaques of psoriasis, probably because the sweat ducts are blocked
by abnormal horn. This can make life difficult for those with widespread
disease who work in the heat - boiler men, for example. If you can't
sweat you can't lose heat, and hyperpyrexia may result.
In erupting,
active psoriasis affecting 30 per cent or more of this skin surface
there is another problem. The increased blood flow causes heat loss,
and in the severest cases can result in hypothermia. Obviously,
outdoor work in the cold is not advisable for psoriatic in an eruptive
phase.
There have been reports of bacterial colonization of the
chronically scaling lesions of plaque-type psoriasis and the infection
of surgical wounds by psoriatic medical staff. Nurses, surgeons
and other operating theatre staff of all types should have regular
bacterial swabs and preferably should avoid direct contact with
open wounds while their psoriasis is active.
Unjustified bar to
employment In some occupations in which there is a pre-employment
medical examination the discovery of psoriasis is a bar to being
accepted. I find this illogical. The one predictable thing about
psoriasis is its unpredictability. There is no way of knowing whether
someone with a small patch of psoriasis will remain someone with
a small patch of psoriasis, become totally disabled by universal
psoriasis or become rash free and rise to be another Henry Ford!
Although there are no statistics to prove it, experience tells me
that excessive loss of time from work because of psoriasis is the
exception rather than the rule. In my view, exclusion from a particular
job because of psoriasis should only occur after considerable heart-searching
and after consideration of the work involved as well as the individual's
ability to do it, at the time of examination.
