Psychologic Factors in Psoriasis: Consequences, Mechanisms, and Interventions
Section snippets
Consequences
Generally accepted estimates of the prevalence of psoriasis are 2% to 3% of the population [8]. Research has shown that psoriasis has the potential for significant psychologic and social morbidity [1], [9], [10], [11], [12]; although estimates vary, generally about one in four patients experiences significant psychologic distress [11]. Dermatologists' ability to identify clinically relevant distress in their patients has been shown to be unsatisfactory [10]. Richards and colleagues [13]
Mechanisms
Evidence for a potential role of psychologic factors in the etiology and pathogenesis of psoriasis is growing; however, the question of whether stress or psychologic distress directly contributes to exacerbation or maintenance of psoriasis is not particularly well established [99]. Despite the recognition by Ginsburg [1] in 1995 of the absence of well-controlled, longitudinal studies examining the relationship between stress and psoriasis, this deficiency has yet to be adequately addressed.
Interventions
In the absence of clear psychophysiologic data, one further source of evidence for the link between stress and psoriasis is the improvement in clinical parameters as a result of psychologic intervention. Although psychologic interventions in psoriasis are few, the most compelling tend to favor an approach to treatment that derives from cognitive and behavioral principles.
Cognitive behavioral therapy (CBT) specifically targets patterns of unhelpful thoughts and beliefs held by patients and the
Brain-skin axis
A key area for future research in psoriasis is the interface between the brain and skin. There is presently insufficient evidence to state categorically that what happens in the skin is a reflection of an individual's psychologic state. The burgeoning evidence of a brain-skin axis is suggestive, however, and many research avenues seem promising, including investigations of factors contributing to hypocortisolism, patient self-monitoring of everyday stressors and the link with the onset,
Summary
This article has examined the literature pertinent to psychologic aspects of psoriasis published since 1995. The studies reviewed have suggested that the consequences of this condition for patients and their families can be significant. Numerous factors seem to mediate the impact of the condition, chiefly beliefs about the consequences, causes, and emotional impact of the condition. Cognitive and behavioral strategies engaged in by patients also seem to have risk and protective properties
References (121)
Psychological and psychophysiological aspects of psoriasis
Dermatol Clin North Am
(1995)- et al.
Perceived stress attributions and psychological stress in psoriasis
J Psychosom Res
(2004) - et al.
Physical and psychologic measures are necessary to assess overall psoriasis severity
J Am Acad Dermatol
(2001) - et al.
Patients with psoriasis and their compliance with medication
J Am Acad Dermatol
(1999) - et al.
The self-administered psoriasis area and severity index is valid and reliable
J Invest Dermatol
(1996) - et al.
Disease severity measures in a population of psoriasis patients: the symptoms of psoriasis correlate with self administered Psoriasis Area and Severity Index Scores
J Invest Dermatol
(1996) - et al.
Why put new wine in old bottles: the need for a biopsychosocial approach to the assessment, treatment, and understanding of unexplained and explained symptoms in medicine
J Psychosom Res
(2000) - et al.
The psychosocial impact of psoriasis: physical severity, quality of life, and stigmatization
Physiol Behav
(2000) - et al.
IDI Multipurpose Psoriasis Research on Vital Experiences (IMPROVE) investigators: measures of clinical severity, quality of life, and psychological distress in patients with psoriasis: a cluster analysis
J Invest Dermatol
(2004) - et al.
Psoriasis causes as much disability as other major medical diseases
J Am Acad Dermatol
(1999)
The burden of psoriasis: a study concerning health-related quality of life among Norwegian adult patients with psoriasis compared with general population norms
J Am Acad Dermatol
Patients with palmoplantar psoriasis have more physical disability and discomfort than patients with other forms of psoriasis: implications for clinical practice
J Am Acad Dermatol
The impact of psoriasis on the quality of life of patients from the 16-center PUVA follow-up cohort
J Am Acad Dermatol
The contribution of perceptions of stigmatisation to disability in patients with psoriasis
J Psychosom Res
Coping and psoriasis—a framework for targeted interventions
J Eur Acad Dermatol Venereol
Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis
J Psychosom Res
Divergent beliefs about psoriasis are associated with increased psychological distress for patients and their partners
J Invest Dermatol
Only limited support for a role of psychosomatic factors in psoriasis: results from a case control study
J Psychosom Res
Alexithymia in patients with psoriasis: clinical correlates and psychometric properties of the Toronto Alexithymia Scale-20
J Psychosom Res
Pathological worrying, illness perceptions, and disease severity in patients with psoriasis
Br J Heal Psychol
What patients with psoriasis believe about their condition
J Am Acad Dermatol
The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient membership survey
Arch Dermatol
Psoriasis in the community: prevalence, severity and patients' beliefs and attitudes towards the disease
Br J Dermatol
Self-reported stress reactivity and psoriasis-related stress of Nordic psoriasis sufferers
J Eur Acad Dermatol Venereol
The effect of severe psoriasis on the quality of life of 369 patients
Br J Dermatol
Recognition of depressive and anxiety disorders in dermatological outpatients
Acta Derm Venereol
Psychiatric morbidity in dermatological outpatients: an issue to be recognised
Br J Dermatol
Increased psychiatric morbidity in female outpatients with skin lesions on visible parts of the body
Acta Derm Venereol
Detection of psychological distress in patients with psoriasis—low consensus between doctor and patient
Br J Dermatol
Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance
Arch Dermatol
Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy (PUVA)
Arch Dermatol
The impact of skin diseases on patients: comparing dermatologists' opinions with research data collected on their patients
Br J Dermatol
Quality of life in psoriasis: the contribution of clinical variables and psoriasis-specific stress
Br J Dermatol
Cost of psoriasis: a study on the morbidity and financial effects of having psoriasis in Australia
Austral J Dermatol
The Salford Psoriasis Index: an holistic measure of psoriasis severity
Br J Dermatol
The application of multiple quality-of-life instruments in individuals with mild-to-moderate psoriasis
Pharmacoeconom
Association between poorer quality of life and psychiatric morbidity in patients with different dermatological conditions
Psychosom Med
The relationship between demographic and clinical variables, and quality of life aspects in patients with psoriasis
Qual Life Res
Quality of life in 6497 Nordic patients with psoriasis
Br J Dermatol
Trivial or terrible? The psychosocial impact of psoriasis
Int J Dermatol
Atopic dermatitis is associated with a decrement in health-related quality of life
Int J Dermatol
Postal questionnaire study of disability in the community associated with psoriasis
BMJ
Experiences of stigmatization play a role in mediating the impact of disease severity on quality of life in psoriasis patients
Br J Dermatol
The bodily suffering of living with severe psoriasis: In-depth interviews with 22 hospitalized patients with psoriasis
Qual Health Res
Use of alternative treatments by patients with psoriasis
Br J Gen Pract
Quality of life, health-state utilities and willingness to pay in patients with psoriasis and atopic eczema
Br J Dermatol
A survey of patients with plaque psoriasis who had not consulted their doctor in the past year
Br J Clin Res
Impaired quality of life of adults with skin disease in primary care
Br J Dermatol
Psoriasis of the nails associated with disability in a large number of patients: results of a recent interview with 1,728 patients
Dermatology
Quality of life and prevalence of arthritis reported by 5,795 members of the Nordic Psoriasis Associations: data from the Nordic Quality of Life Study
Acta Derm Venereol
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