Psoriasis and Psycho-Dermatology

Abstract

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.

Psoriasis, Depression, and Inflammatory Overlap: A Review

“…These limited studies demonstrate the potential utility of psychotherapy techniques as adjuncts in the treatment of psoriasis and mental health conditions. However, the variety of interventional methods and outcome measures created difficulty in making comparisons across studies [51,52].…”

Strategies to reduce stigma related to visible chronic skin diseases: a systematic review

“…Thus far, less attention has been paid to stigma in the dermatological setting. First research results indicate that patients with different visible chronic skin diseases experience discrimination and stigmatization . Accordingly, they face double burden of disease: dealing with a dermatological diagnosis accompanied by the potential of being stigmatized.…”

Major Depression and Psoriasis: A Psychodermatological Phenomenon

“…Elevation in the concentration of proinflammatory cytokines, including prostaglandin E2, C-reactive protein (CRP), TNF-α, IL-1β, IL-2, and IL-6, has also been connected with major depressive disorder, and there may potentially exist a dose response with a higher concentration of inflammatory markers linked to more severe depressive morbidity [41,42]. Additionally, proinflammatory cytokines have been shown to induce sickness behavior and depressive symptoms in dogs, and this may also occur in humans [43]. Serotonin transporter availability and function is increased by proinflammatory cytokines, thus triggering depression in rodent models.…”