Fast Five Quiz: The Psychosocial Burden of Psoriasis

Medscape

7 hours ago

The relationship between psoriasis and psychosocial symptoms tends to be a cyclical one. Psychological stressors can exacerbate the disease through overactivation of the hypothalamic-pituitary-adrenal axis and increased release of pro-inflammatory cytokines. Conversely, the cutaneous inflammatory response can cause body disfigurement, stigmatization, and ultimately anxiety and depression.
What do you know about the psychosocial burden of psoriasis? Test your knowledge with this quick quiz.
As patients with psoriasis experience a relapsing course, over time they often face a lower quality of life owing to their symptoms, social stigmas, and impacted self-esteem. For example, a review that evaluated the psychological comorbidities associated with this condition reported that patients with psoriasis who have visible psoriatic lesions face a significant negative impact on their quality of life. Further, Dermatology Life Quality Index (DLQI) and Health-Related Quality of Life (HRQOL) scores can be influenced by both lesion location and severity; increased Psoriasis Area and Severity Index scores have been linked to higher DLQI scores as well, which indicates that "as disease severity worsens, so does the overall impact on quality of life." Patients can experience any form of psychological and social distress as a result, not just anxiety.
Although depression in psoriasis is common, the psychosocial impact of the disease has not been mainly linked with fear of developing psoriatic arthritis.
Learn more about the prognosis of psoriasis.
In patients with psoriasis, female sex has been identified as a risk factor for depression in this population. A systematic review exploring the burden of depression in psoriasis reported a higher overall prevalence of depression in females over males. This is consistent with other recent data; however, male patients with psoriasis still seem to have an increased prevalence of depression compared with males without psoriasis. Ultimately, current data point to the fact that the prevalence of depression is higher among all patients with psoriasis, but female patients with skin disease appear to be at greater risk than their male counterparts.
Younger age is more frequently associated with depression, though older individuals with psoriasis can still be affected.
Learn more about the prognosis of psoriasis.
Pruritus is one of the main symptoms of plaque psoriasis. Although it varies in intensity, this symptom should not be disregarded owing to its significant impact on mental health. Anxiety and depression are linked to plaque psoriasis; these psychological comorbidities can increase the frequency and severity of pruritus, which results in an increased tendency to scratch; conversely, the increased pruritus and scratching also worsens anxiety and depression.
It is estimated that 40% of patients with plaque psoriasis experience nail involvement. Further, nail involvement has been linked to "significant psychological distress, including anxiety and depression."
Though any severity of skin pain can be linked to psychosocial burden in patients with chronic dermatological disorders such as plaque psoriasis, data have shown that patient-reported skin pain is usually of "moderate intensity" when HRQOL is negatively affected.
Learn more about the signs and symptoms of plaque psoriasis.
Psychosocial interventions have been shown to improve DLQI scores in patients with psoriasis. Specifically, the addition of mindfulness therapy to treatment as usual for psoriasis has been found to improve DLQI the most compared with other studied interventions (treatment as usual alone, psoriasis and lifestyle education, and online-based management). Cognitive-behavioral therapy in conjunction with pharmacological therapy has also been shown to improve psychosocial and disease-related symptoms. This result is most likely owing to stress as an identified trigger for psoriasis flares and decreased DLQI scores, with mindfulness therapy aiming to reduce stress and therefore flares.
This is consistent with another recent review finding improvement in both disease severity and DLQI scores with various forms of mindfulness intervention. However, cognitive-behavioral therapy and treatment as usual were most effective for the other outcome measures, including anxiety, depression, and treatment adherence; mindfulness therapy was the least effective intervention for adherence. Education regarding psoriasis and lifestyle management that can help with symptoms was shown to improve HRQOL.
Learn more about the treatment of psoriasis.
Biologic therapy has been shown to effectively treat depression symptoms in the setting of psoriasis. Other therapeutic approaches that are effective for depression symptoms in psoriasis were conventional systemic therapy and phototherapy. Taken together, evidence supports the theory that improved skin disease is associated with improved psychiatric disease.
Patients with psoriasis have a higher prevalence of hypertension. Beta-blockers in this setting can worsen psoriasis, which can negatively affect depression symptoms. Overall, evidence of a link between depression symptoms and beta-blocker use is mixed.
Some psychotropic medications can cause flares in skin disease, including lithium, fluoxetine, and bupropion; these agents should therefore be prescribed with caution in this population. Similarly, the link between depression symptoms and psychotropic medication use is inconsistent.
Though certain phosphodiesterase 4 inhibitors can improve psoriasis symptoms and can improve quality of life, data indicate that they can worsen depression symptoms.
Learn more about the treatment of psoriasis.
Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.