Psychologic factors in psoriasis: Consequences, mechanisms, and interventions

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 depending on the outcome being studied and seem more helpful for anxiety, disability, and quality of life rather than depression. Alexithymia - a deficit in the self-regulation of emotion - also seems to function as a risk factor for the emergence and maintenance of distress, and excessive worry may have significant implications for resistance of disease to treatment. Although inconclusive, studies investigating HPA axis function suggest that hypocortisolism may be an important feature of stress-responsive psoriasis. Given the high levels of distress and the proposed interaction between psychologic factors and disease process, structured psychologic interventions that are integrated into standard care packages are likely to be of most benefit to patients with this complex disease. The next decade will reveal findings from studies currently being undertaken by research teams worldwide that will further understanding of the interplay between different, yet related facets of this condition. These facets include, but are not restricted to, the use of brain imaging in the context of acute stress in psoriasis, the role of early adversity as a risk factor in chronicity, family perspectives and stigma, in-depth examinations of the interplay between stress and the HPA system, interventions targeting specific psychologic processes and outcomes, and the use of longitudinal designs to address adequately the putative stress-psoriasis link. A truly collaborative research and clinical impetus that may facilitate meaningful changes for patients may be closer than is realized.