Elsevier

Dermatologic Clinics

Volume 23, Issue 4, October 2005, Pages 681-694
Dermatologic Clinics

Psychologic Factors in Psoriasis: Consequences, Mechanisms, and Interventions

https://doi.org/10.1016/j.det.2005.05.022Get rights and content

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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

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