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Psoriasis is a chronic disease, mediated by the human immune system, based on a polygenic vulnerability, with cutaneous and systemic manifestations and substantial negative effects on the quality of life of patients. The physical and psychological impacts of psoriasis affect all areas of patient's functioning. Likewise, the prevalence of depression and anxiety in patients with psoriasis is significantly higher than that in the general population, and the quality of life is lower when compared to patients with different dermatological conditions. Both anxiety and depression may increase the clinical severity of psoriasis. Although psychiatric disorders in patients with psoriasis may be secondary to the stress due to the shame and social anxiety related to the skin lesions, the high rate of comorbidity has led to hypothesize that there may be common pathophysiological (psychodermatological) mechanisms involved. Inflammation is a key factor, since alterations in inflammatory modulators such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system have been described. This narrative review of the literature highlights the psychodermatological aspects of the etiopathogenesis of psoriasis as well as the impact of illness on patients' personal identity, functioning, and professional, social, and family areas.

Background: COVID-19 physical distancing measures can potentially increase the likelihood of mental disorders. It is unknown whether these measures are associated with depression and anxiety. Objectives: To investigate meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how implementation of mitigation strategies (i.e. public transportation closures, stay-at-home orders, etc.) impacted such disorders. Data sources: Pubmed, MEDLINE, Web of Science, BIOSIS Citation Index, Current Content Connect, PsycINFO, CINAHL, medRxiv, and PsyArXiv databases for depression and anxiety prevalences; Oxford Covid-19 Government Response Tracker for the containment and closure policies indexes; Global Burden of Disease Study for previous levels of depression and anxiety. Study eligibility criteria: Original studies conducted during COVID-19 pandemic, which assessed categorical depression and anxiety, using PHQ-9 and GAD-7 scales (cutoff ≥ 10). Participants and interventions: General population, healthcare providers, students, and patients. National physical distancing measures. Study appraisal and synthesis methods: Meta-analysis and meta-regresssion. Results: In total, 226,638 individuals were assessed within the 60 included studies. Global prevalence of both depression and anxiety during COVID-19 pandemic were 24.0% and 21.3%, respectively. There was a wide variance in the prevalence of both anxiety and depression reported in different regions of the world and countries. Asia, and China particularly, had the lowest prevalence of both disorders. Regarding the impact of mitigation strategies on mental health, only public transportation closures increased anxiety prevalence. Limitations: Country-level data on physical distancing measures and previous anxiety/depression may not necessarily reflect local (i.e., city-specific) contexts. Conclusions and implications of key findings: Mental health concerns should not be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a concurrent epidemic. Our data provides support for policy-makers to consider real-time enhanced mental health services, and increase initiatives to foster positive mental health outcomes.

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