Stress and psoriasis: Exploring the link through the prism of hypothalamo-pituitary-adrenal axis and inflammation

Transcutaneous auricular vagus nerve stimulation inhibits mental stress-induced cortisol release-Potential implications for inflammatory conditions

Elevated glucocorticoid levels with reduced glucocorticoid responsiveness have been reported in chronic inflammatory conditions. Activation of neurons in the nucleus of the solitary tract by transcutaneous auricular vagus nerve stimulation (taVNS) may activate inhibitory pathways projecting to the hypothalamic paraventricular nucleus (PVN), thus inhibiting corticotropin-releasing hormone (CRH) release and improving glucocorticoid dysfunction in chronic inflammatory conditions. Healthy adults (n = 12) participated in experimental (taVNS) and control (sham-taVNS) sessions at least 4 days apart. A 30-min baseline recording was followed by 30 min of taVNS or sham-taVNS and 40 min of recovery. Ten minutes into taVNS or sham-taVNS, a mental arithmetic stress test (MAST) was conducted for 15 min. The MAST increased heart rate, low frequency (LF) heart rate variability (HRV), and the LF to high frequency ratio of HRV, confirming sympathetic activation. Salivary cortisol levels during the MAST were lower during taVNS (49.5 ± 48.0% from baseline; mean ± SD) compared to sham-taVNS (106.0 ± 81.1% from baseline; mean ± SD; p < 0.05). In a psoriasis patient, daily taVNS for 3 months reduced diurnal salivary cortisol levels from 58.2 ± 35.2 (ng/mL)*h (mean ± SD) to 34.9 ± 13.8 (ng/mL)*h (mean ± SD). While it is possible that taVNS inhibited CRH-releasing neurons in the PVN, our study design did not allow to confirm this potential mechanism.

Potentially traumatic events, posttraumatic stress symptoms, and skin-related quality of life among adults with self-reported skin disease symptoms

The connection between stress and skin disease has been extensively documented; however, there are no empirical studies investigating the incidence of traumatic event exposure and posttraumatic stress (PTS) symptoms among dermatology patients. To address this gap in the literature and begin to understand the associations between PTS symptoms and skin disease symptoms, this study used a sample of adults with self-reported skin disease symptoms to examine: (1) rates of potentially traumatic event (PTE) exposure and PTS symptoms; and (2) the association between PTS symptoms and skin-related quality of life, controlling for relevant covariates. Data were collected online through Cloud Research, and participants completed a battery of self-report measures. The sample included 310 participants (68.4% female) who endorsed current skin disease symptoms. Results indicated that 47.1% of participants endorsed clinical levels of PTS symptoms. Consistent with hypotheses, greater levels of PTS symptoms were associated with worse skin-related quality of life, and this association was particularly robust for arousal-related symptoms. Results shed light on the occurrence of trauma-related experiences among individuals with self-reported skin disease and indicate a link between PTS symptoms and the perceived burden of skin disease symptoms on daily living. However, this study was cross-sectional and relied on self-report measures; therefore, findings should be interpreted with caution, particularly since diagnoses could not be verified. Replication of this work in dermatology patients is needed to further understand these connections.

Vitiligo - a disease: A position paper on stigmatization, life quality impairment and psychosocial comorbidity

Vitiligo is a common disorder characterized by the visible loss of skin pigmentation. Non-segmental vitiligo (NSV) is the major subtype. The disease is caused by autoimmune-mediated destruction of melanocytes. Vitiligo leads to stigmatization and a significant reduction in quality of life. Disregarding the psychosocial burden, vitiligo is sometimes viewed solely as a cosmetic problem and, according to a global survey, is diagnosed on average only after 2.4 years. This delay contributes to a considerable burden of disease, including suicidal ideation. Stigmatization promotes the development of psychological comorbidities such as anxiety and depressive disorders, with prevalence rates varying by country and study (0.1%-67.9%). Data for Germany are heterogeneous and largely based on estimates. Due to psychosocial factors, the inflammatory component, and a higher incidence of somatic comorbidities, NSV may be regarded as an inflammatory systemic disease. We recommend optimizing care by incorporating the assessment of quality of life as a standard in routine care, in addition to monitoring disease activity. Moreover, early screening for psychological comorbidities is crucial to initiate appropriate treatment before the condition becomes chronic and cumulative (irreversible) impairments occur. The goal is a personalized and patient-centered integrated care approach that sustainably improves the health status of those affected.

Stressful life events and the occurrence of skin cancer

OBJECTIVE

It is widely acknowledged that emotional states can influence skin conditions, yet limited research has delved into the impact of stress on skin cancer development. This retrospective study sought to expand the perspective on skin cancer risk factors by investigating the complex relationship between stressful life events and the incidence of skin cancer.

METHODS

The sample included 268 individuals followed-up in a dermatological clinic, in three groups: Patients who had previously been diagnosed with cutaneous melanoma and are currently in remission (32%), those who had been diagnosed with non-melanoma skin cancer (30%), and a control group who are at risk for skin cancer (38%). Participants filled in questionnaires regarding childhood and adulthood life events, and loss and gain of resources following their subjectively most stressful event in adulthood. Multinomial logistic regression was used to examine the associations of life events with skin cancer occurrence, and mediating and moderating effects of resource loss/gain.

RESULTS

Adverse childhood experiences were associated with melanoma occurrence, with the melanoma group reporting significantly more such experiences compared to the control group (p < 0.001). Resource loss from subjectively significant stressful life events in adulthood partially mediated the association between adverse childhood experiences and melanoma incidence.

CONCLUSIONS

The findings suggest that there may be intricate connections between stress, life events, adaptation to change, and skin cancer, which future research may further unravel. This study underscores the need for a more comprehensive approach to stress management, coping strategies development, and skin cancer prevention in healthcare settings.

Psoriasis: What Is New in Markers of Disease Severity?

Introduction. Psoriasis is a chronic inflammatory skin disease and is the result of the interaction between numerous external and internal factors. Psoriasis presents a wide range of skin manifestations encompassing individual lesions varying from pinpoint to large plaques that can evolve into generalised forms. The lesions mirror the pathophysiological mechanisms involved in psoriasis pathogenesis, such as inflammation, dysregulation of immune response, uncontrolled proliferation of keratinocytes and angiogenesis. In this article, we present the latest advances achieved regarding markers that correlate with psoriasis severity. Material and method. We have performed a narrative review on markers of psoriasis severity, including articles published between March 2018-March 2023. Results. We have identified four categories of markers: inflammation markers, oxidative stress markers, hormonal markers and cancer-related markers. The main focus was on inflammation biomarkers, including immunomodulatory molecules, haematological parameters, inflammatory cells and costimulatory molecules. Conclusions. The analysed data indicate that markers associated with inflammation, oxidative stress and hormones, and cancer-related markers could be useful in assessing the severity of psoriasis. Nevertheless, additional research is required to ascertain the practical importance of these biomarkers in clinical settings.