The findings have important theoretical and clinical implications for psychological management of patients with psoriasis and eczema. Treatment protocols may benefit by targeting schemas. Further studies are needed to investigate the benefits of schema-focused therapy in patients with skin disease.

Objectives: To determine the prevalence of skin disease in a rural Tanzanian community and to investigate the health-seeking behavior of this community. Design:The study was in 3 parts: (1) 120 heads of households were interviewed to determine the factors that influence the families' health-seeking behavior;(2) the 800 members of these families were examined for evidence of skin disease; and (3) a focus group discussion was held with influential members of the community to get a broader view of health-seeking behavior.

IMPORTANCE Therapies that reduce psoriasis symptoms may improve work productivity. OBJECTIVE To assess the effect of ixekizumab therapy on work productivity, measured by the Work Productivity and Activity Impairment-Psoriasis (WPAI-PSO). DESIGN, SETTING, AND PARTICIPANTS Three multicenter, randomized double-blind phase 3 trials conducted during the following periods:

This study provides statistically significant evidence that arts-based observational skills training can improve the observational skills of doctors and nurses. It is important not to overstate the clinical significance of these findings, and to recognise that observational skills are just one of many complex and subtle factors affecting the quality of the clinical process. Further research is needed to assess the existence, nature and clinical significance of longer-term benefits, and to identify differences between professional groups.

Ustekinumab is a novel biologic agent for psoriasis. When used in everyday clinical practice it demonstrates high levels of short-term therapeutic efficacy with an acceptable short-term safety profile.

Reports of distress were common, and for many it was long-standing. Some reported low self-esteem and self-denigration bordering on self-loathing, and described being hypervigilant and in a constant battle with their skin. Many people did not expect to have intimate relationships, resulting in reduced social support for patients in the future. This research underscores the need for patient support and psychological treatment to be made available as part of routine care.

IntroductionPsoriasis is a common, long-term skin condition associated with high levels of psychological distress and considerable life impact. The impact of psoriasis, beyond the skin, is often not recognised and under-treated.MethodsThis paper explores the relationship between psychological distress and psoriasis including reference to the ‘brain–skin access’. The life impact of psoriasis is discussed and pharmacological interventions which affect distress associated with psoriasis and psychological interventions are reviewed. Evidence from peer-reviewed journals and controlled trials inform the text.ResultsPsoriasis has a profound impact on mental health and well-being which is under-recognised by clinicians. The sympathetic adrenal medullary axis and hypothalamic pituitary adrenal axis are likely to be involved in the onset of psoriasis and there may also be an effect from inflammation in the skin on the central release of corticotrophin-releasing hormone. Psoriasis can be stigmatising and may affect all aspects of life including relationships, employment, social life and leisure activities. There is some evidence for psychological interventions being effective in the management of distress associated with psoriasis and psoriasis itself. Studies, however, have used disparate outcomes and methods and largely involve low numbers of patients. There is very limited access to psychological support for the patients with psoriasis despite evidence of high levels of psychological distress and considerable life impact.ConclusionsPsoriasis is a long-term skin condition associated with high levels of distress and considerable life impact, both of which are under-recognised. Routine screening for distress with access to effective treatment is required. There is a need for high-quality studies to assess the effect of psychological intervention in patients with psoriasis both to inform guidance and facilitate the provision of effective psychological support services.

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