1
|
Laskowski M, Schiöler L, Åberg M, Abuabara K, Wennberg AM, Gustafsson H, Torén K. Influence of stress resilience in adolescence on long-term risk of psoriasis and psoriatic arthritis among men: A prospective register-based cohort study in Sweden. J Eur Acad Dermatol Venereol 2024. [PMID: 38767960 DOI: 10.1111/jdv.20069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Although stress is considered to be a negative factor for psoriasis, no convincing scientific evidence of this association exists, largely because of difficulties in measuring stress. Stress resilience is the ability to cope with and adapt to stressful events. Stress resilience can be measured in a standardized way and used as a marker for chronic stress. OBJECTIVES The objective of this study is to investigate whether low stress resilience in adolescence increases the risk for onset of psoriasis and psoriatic arthritis later in life. METHODS A cohort of Swedish men (mean age 18.3 years), enrolled in compulsory military service between 1968 and 2005, was created using data from the Swedish Military Service Conscription Register (n = 1,669,422). Stress resilience at conscription was estimated using standardized semi-structured interviews, and was divided into three categories: low, medium and high. The men were followed from conscription until new-onset psoriasis or psoriatic arthritis, death or emigration or at the latest until 31 December 2019. Cox regression models adjusted for confounders at conscription were used to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psoriasis and psoriatic arthritis. RESULTS Men in the lowest stress resilience category had an increased risk of psoriasis and psoriatic arthritis (HR 1.31 (95% CI 1.26-1.36) and 1.23 (95% CI 1.15-1.32), respectively), compared with those in the highest stress resilience category. When including only hospitalized patients the HRs for psoriasis and psoriatic arthritis in the lowest stress resilience group were 1.79 (1.63-1.98) and 1.53 (1.32-1.77), respectively. CONCLUSIONS This large, prospective register study suggests that low stress resilience in adolescence is associated with an increased risk of incident psoriasis among men. The results indicate that patients with psoriasis have an inherent psychological vulnerability, and highlight the importance of addressing psychological well-being in the management of psoriasis.
Collapse
Affiliation(s)
- M Laskowski
- Department of Dermatology and Venereology, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Åberg
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - K Abuabara
- Department of Dermatology, University of California, San Francisco, California, USA
| | - A-M Wennberg
- Department of Dermatology and Venereology, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Gustafsson
- Department of Physiology, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Aguayo-Carreras P, Ruiz-Carrascosa JC, Ruiz-Villaverde R, Molina-Leyva A. Four years stability of type D personality in patients with moderate to severe psoriasis and its implications for psychological impairment. An Bras Dermatol 2021; 96:558-564. [PMID: 34274184 PMCID: PMC8441460 DOI: 10.1016/j.abd.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Psoriasis is a systemic auto-inflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D is a stable personality trait in healthy subjects but there is no data regarding its stability in patients with moderate-severe psoriasis. Objectives To assess the stability of type D personality in patients with moderate to severe psoriasis as well as assessing the influence of type D personality on anxiety and depression. Methods Prospective cohort study. Forty psoriasis patients with type D personality and sixty-six patients with psoriasis without type D personality were included in the study. Participants completed the DS14 test and HADS at baseline and four years later. Results At baseline, the prevalence of type D personality was 37.7% and at week 208 it was 27.3%. The stability of type D personality was higher in patients with an incomplete education level and in those who were separated/divorced or windowed. During follow-up, 15% of patients developed type D personality. Male sex, having topical treatment, the presence of previous depression, anxiety, and high levels of negative affectivity at baseline increase the risk of developing type D personality. Study limitations Sample size, psoriasis severity restricted to moderate and severe and all patients being under treatment for psoriasis. Conclusions The presence of type D personality varies over time in psoriasis patients. Therefore, type D personality is possibly more a state than a trait phenomenon, modified by environmental factors. Type D personality is associated with a higher risk of anxiety.
Collapse
|
3
|
Founta O, Adamzik K, Tobin AM, Kirby B, Hevey D. Psychological Distress, Alexithymia and Alcohol Misuse in Patients with Psoriasis: A Cross-Sectional Study. J Clin Psychol Med Settings 2020; 26:200-219. [PMID: 30206746 DOI: 10.1007/s10880-018-9580-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study investigates (a) the prevalence of psychological distress, alexithymia and alcohol misuse in psoriasis patients; and (b) the relationship between psoriasis severity, alexithymia, alcohol and psychological distress in patients with psoriasis. A cross-sectional study was conducted. Outpatients (n = 184) with moderate to severe psoriasis completed a psychological screening battery. Measures included the Hospital Anxiety and Depression Scale, the Penn State Worry Questionnaire, the twenty-item Toronto Alexithymia Scale, the Dermatology Life Quality Index, the Psoriasis Area and Severity Index, the Self-Administered Psoriasis Area and Severity Index, and the Alcohol Use Disorders Identification Test. Demographic, clinical details and information on knowledge of psychosocial issues, alcohol and confidence on coping with distress and talking to others about psoriasis was also gathered. Alexithymia was associated with anxiety, depression and worry; subjective psoriasis severity was associated with worry. Alcohol misuse was related to anxiety and worry, but not to depression. Appropriate identification and treatment of alcohol difficulties and psychological distress of patients with psoriasis is needed.
Collapse
Affiliation(s)
- Ourania Founta
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland.
| | - Karoline Adamzik
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Anne-Marie Tobin
- Dermatology Department, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
| | - Brian Kirby
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital and School of Health Sciences, UCD, Dublin 4, Ireland
| | - David Hevey
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
4
|
Yang H, Zheng J. Influence of stress on the development of psoriasis. Clin Exp Dermatol 2019; 45:284-288. [PMID: 31592542 DOI: 10.1111/ced.14105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2019] [Indexed: 01/18/2023]
Affiliation(s)
- H. Yang
- Department of Dermatology Rui Jin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China
| | - J. Zheng
- Department of Dermatology Rui Jin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China
| |
Collapse
|
5
|
Sharif K, Watad A, Coplan L, Lichtbroun B, Krosser A, Lichtbroun M, Bragazzi NL, Amital H, Afek A, Shoenfeld Y. The role of stress in the mosaic of autoimmunity: An overlooked association. Autoimmun Rev 2018; 17:967-983. [PMID: 30118900 DOI: 10.1016/j.autrev.2018.04.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022]
Abstract
Stress is defined as the pscyophysiological reaction in which the steady state is disturbed or threatened. Stress is not always perceived as a negative response. Stress results when environmental demands exceed an individuals' adaptive capacities. Autoimmune diseases are heterogeneous group of chronic diseases which occur secondary to loss of self antigen tolerance. The etiopathogenesis of autoimmune disease is uncertain. Genetic factors as well as environmental factors appear to interplay, leading to a cascade of events resulting in disease onset. Stress has been postulated to play a role in disease onset in the genetically susceptible patients. During the stress response, catecholamines and glucocorticoids are released from locus coeruleus and adrenal gland. These biomolecules exert control over various immune cells in the innate and adaptive arms of the immune system, thereby altering the cytokine profile released. The increase of IL-4 promotes T-helper 2 (Th2) cell differentiation, while the decrease in IL-12 and the increased IL-10 production reduce the number of T-helper 1 (Th1) cells. The relationship between stress and autoimmune diseases is intricate. Stress has been shown to be associated with disease onset, and disease exacerbations in rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Graves' disease as well as other autoimmune conditions. In certain conditions such as psoriasis, stress has been implicated in delaying lesion clearance upon the application of standard treatment regimes. Finally, psychological therapy and cognitive behavioral therapy aimed to reduce stress levels was shown to be effective in influencing better outcomes in many autoimmune diseases. The purpose of this paper is to closer inspect the clinical evidence regarding the role of stress on influencing the various aspects of disease entities.
Collapse
Affiliation(s)
- Kassem Sharif
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Louis Coplan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Alec Krosser
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Howard Amital
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arnon Afek
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Head of The Mosaic of Autoimmunity Project, Saint Petersburg State University, Israel; Head of The Mosaic of Autoimmunity Project, Saint Petersburg State University, Russia.
| |
Collapse
|
6
|
Snast I, Reiter O, Atzmony L, Leshem YA, Hodak E, Mimouni D, Pavlovsky L. Psychological stress and psoriasis: a systematic review and meta-analysis. Br J Dermatol 2018; 178:1044-1055. [PMID: 29124739 DOI: 10.1111/bjd.16116] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psychological stress has long been linked with the exacerbation/onset of psoriasis. OBJECTIVES To determine if antecedent psychological stress is associated with the exacerbation/onset of psoriasis. METHODS A search of the PubMed, PsycINFO, Cochrane library and ClinicalTrials.gov databases was performed. Surveys evaluating beliefs about stress reactivity were analysed separately. Suitable studies were meta-analysed. RESULTS Thirty-nine studies (32 537 patients) were included: 19 surveys, seven cross-sectional studies, 12 case-control studies and one cohort study. Forty-six per cent of patients believed their disease was stress reactive and 54% recalled preceding stressful events. Case-control studies evaluating stressful events rates prior to the exacerbation (n = 6) or onset (n = 6) of psoriasis varied in time lag to recollection (≤ 9 months to ≥ 5 years). Pooling five studies evaluating stressful events preceding onset of psoriasis gave an odds ratio (OR) of 3·4 [95% confidence interval (CI) 1·8-6·4; I2 = 87%]; the only study evaluating a documented stress disorder diagnosis reported similar rates between patients and controls (OR 1·2, 95% CI 0·8-1·8). Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, whereas two found more frequent/severe preceding events among patients with psoriasis. A small prospective cohort study reported a modest association between stress levels and exacerbation of psoriasis (r = 0·28, P < 0·05). CONCLUSIONS The association between preceding stress and exacerbation/onset of psoriasis is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with exacerbation/onset of psoriasis.
Collapse
Affiliation(s)
- I Snast
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - O Reiter
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - L Atzmony
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Y A Leshem
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Hodak
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Mimouni
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Pavlovsky
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| |
Collapse
|
7
|
Dixon LJ, Witcraft SM, McCowan NK, Brodell RT. Stress and skin disease quality of life: the moderating role of anxiety sensitivity social concerns. Br J Dermatol 2018; 178:951-957. [PMID: 29078254 DOI: 10.1111/bjd.16082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stress is an important factor in the onset, exacerbation and reoccurrence of many skin diseases. Little is known about psychological risk factors that affect the association between stress and dermatological conditions. One relevant factor that may modulate this link is anxiety sensitivity (AS) social concerns - the propensity to respond fearfully to anxiety-related sensations (e.g. sweating, flushing) owing to perceived social consequences (e.g. rejection or humiliation). OBJECTIVES To gain insight into psychological factors affecting skin disease, we examined the moderating role of AS social concerns in the relationship between stress and skin disease quality of life (QoL). METHODS Participants [n = 237 (161 female), mean ± SD age 34·18 ± 9·57 years] with active skin disease symptoms were recruited online and completed questionnaires assessing stress, AS social concerns, skin disease QoL and global skin disease symptom severity. RESULTS AS social concerns moderated the association between stress and skin-related emotional and social functioning in adults with skin disease. Stress was a significant predictor of the impairment associated with skin disease. CONCLUSIONS Stress was linked to skin disease-related emotional and functional impairment associated with skin disease among individuals with high AS social concerns. These results highlight the potential for AS reduction interventions to break the vicious cycle of stress and skin disease symptoms and to improve psychosocial well-being in dermatology patients.
Collapse
Affiliation(s)
- L J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, MS, 38677, U.S.A.,Department of Dermatology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, U.S.A
| | - S M Witcraft
- Department of Psychology, University of Mississippi, P.O. Box 1848, MS, 38677, U.S.A
| | - N K McCowan
- Department of Dermatology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, U.S.A
| | - R T Brodell
- Department of Dermatology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, U.S.A
| |
Collapse
|
8
|
Remröd C, Sjöström K, Svensson Å. Subjective stress reactivity in psoriasis - a cross sectional study of associated psychological traits. BMC DERMATOLOGY 2015; 15:6. [PMID: 25934133 PMCID: PMC4423403 DOI: 10.1186/s12895-015-0026-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/22/2015] [Indexed: 02/08/2023]
Abstract
Background Stress or psychological distress is often described as a causative or maintaining factor in psoriasis. Psychological traits may influence the appraisal, interpretation and coping ability regarding stressful situations. Detailed investigations of psychological traits in relation to stress reactivity in psoriasis are rare. The aim of this study was to examine whether patients with psoriasis who report an association between psychological distress and exacerbation, “stress reactors” (SRs), differ psychologically from those with no stress reactivity “non-stress reactors” (NSRs). Methods This cross-sectional study was conducted among 101 consecutively recruited outpatients with plaque psoriasis. A psychosocial interview was performed including questions concerning stress reactivity in relation to onset and exacerbation. Three validated self-rating scales were used: Spielberger State-Trait Anxiety Inventory (STAI, Form-Y), Beck Depression Inventory (BDI-II) and Swedish Universities Scales of Personality (SSP). Independent samples t-tests, Chi-square tests and one-way ANOVA analyses were used for group comparisons when appropriate. A logistic regression model was designed with SR as the dependent variable. Results Sixty-four patients (63%) reported a subjective association between disease exacerbation and stress (SRs). Patients defined as SRs reported significantly higher mean scores regarding state and trait anxiety, depression, and also five SSP scale personality traits, i.e. somatic trait anxiety, psychic trait anxiety, stress susceptibility, lack of assertiveness and mistrust, compared with NSRs. In multivariate analysis, SSP-stress susceptibility was the strongest explanatory variable for SR, i.e. OR (95% CI) = 1.13 (1.02 – 1.24), p = 0.018. Conclusion According to our results, patients who perceive stress as a causal factor in their psoriasis might have a more vulnerable psychological constitution. This finding suggests important opportunities for clinicians to identify patients who may benefit from additional psychological exploration and support.
Collapse
Affiliation(s)
- Charlotta Remröd
- Department of Dermatology and Venereology, University of Lund, Hudkliniken, Skåne University Hospital, Jan Waldenströmsg. 16, Malmö, 205 02, Sweden.
| | - Karin Sjöström
- Psychiatric consultant at the Department of Dermatology and Venereology, Hudkliniken, Skåne University Hospital, Jan Waldenströmsg. 16, Malmö, 205 02, Sweden.
| | - Åke Svensson
- Department of Dermatology and Venereology, University of Lund, Hudkliniken, Skåne University Hospital, Jan Waldenströmsg. 16, Malmö, 205 02, Sweden.
| |
Collapse
|
9
|
Fordham B, Griffiths CE, Bundy C. Can stress reduction interventions improve psoriasis? A review. PSYCHOL HEALTH MED 2013; 18:501-14. [DOI: 10.1080/13548506.2012.736625] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
10
|
Abstract
Dermatological conditions are intimately related to stress. There was a great interest in this field in the last years. Stress could be involved as a trigger factor for a lot of cutaneous diseases: alopecia areata, psoriasis, vitiligo, lichen planus, acne, atopic dermatitis, urticaria. For other conditions: seborrheic dermatitis, hyperhydrosis, herpes, pemphigus, a.s.o, there are anecdotal notices. On the other hand, the skin disease itself could induce a secondary stress for the patient, influencing his quality of life. The stress per se is less important than the “perceived stress”, the patient’s perception of the stressful situation. This perception could be influenced by the psychological state of the patient. Anxiety, depression could change the perception of the event. It is important to take care of these aspects during the consultation. A good cooperation with psychiatrist or/and psychologist could improve the results, besides the specific therapy.
Collapse
|
11
|
Rieder E, Tausk F. Psoriasis, a model of dermatologic psychosomatic disease: psychiatric implications and treatments. Int J Dermatol 2012; 51:12-26. [PMID: 22182372 DOI: 10.1111/j.1365-4632.2011.05071.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psoriasis is a common dermatologic disorder with psychiatric comorbidity that often goes undetected and untreated. Psoriasis has higher associations with psychiatric illness than do other dermatologic conditions. We conducted a comprehensive qualitative review of all published medical literature on psoriasis and psychiatric comorbidities since 2005. We found that psoriasis patients suffer psychiatric and psychosocial morbidity that is not commensurate with the extent of cutaneous lesions. Biologic therapies and nonpharmacologic psychosocial interventions show promise in treating comorbid psychiatric illness. The main limitations of this review are the low quality of published studies and the infrequent use of basic science endpoints in reporting treatment outcomes. The literature examining the psychiatric comorbidity of psoriasis is expanding but remains of variable quality. Stronger studies will be necessary to more accurately estimate comorbidities and help identify and comprehensively treat suffering patients.
Collapse
Affiliation(s)
- Evan Rieder
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
| | | |
Collapse
|
12
|
Abstract
Psoriasis is a chronic, relapsing, cutaneous condition with 1-2% prevalence in the general population. There are many factors involved in the induction and/or exacerbation of psoriasis of which stress is a well-known trigger factor in the appearance or exacerbation of psoriasis. Stress reaction in patients with psoriasis is probably mediated by the hypothalamic-pituitary-adrenal relationship with immunologic effects. Stress response involves increased levels of neuroendocrine hormones and autonomic neurotransmitters. Psychological stress or an abnormal response to stressors has been found to modify the evolution of skin disorders such as psoriasis. It can also have substantial psychological, and psychosocial impact on a patient's quality of life. Treatment regimens include stress-reduction strategies, such as biofeedback, meditation, yoga, and self-help approaches. This review focuses the relationship between psoriasis and stress, especially relating to psychosocial, psychological, and emotional stress aspects.
Collapse
Affiliation(s)
- Kabbur H Basavaraj
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS University, Mysore-570015, Karnataka, India.
| | | | | |
Collapse
|
13
|
Abstract
BACKGROUND The purpose of the study was to evaluate the possible role of stress before the onset/extension/recurrence of psoriasis. PATIENTS AND METHOD One hundred and sixty-nine outpatients with psoriasis and 169 age and gender matched controls were enrolled. The design was a case-control study (controls had skin diseases with low psychosomatic component). Stressful life events were evaluated using Holmes and Rahe's Social Readjustment Rating Scale. RESULTS In the psoriatic group, there was a female predominance (66%) and a median age 47.55 years (SD = 20.32). In all, 10.65% of patients had family history of psoriasis. More than 54% of cases experienced at least one stressful event (47.36% for onset, 63.51% for recurrence/extension), compared with 19.52% of controls (chi(2) = 42.71, P < 0.0001). The odds ratio was 4.92. There was a significant difference in the mean number of stressful events between patients and controls (P < 0.0001). Women with psoriasis vulgaris and men with guttate psoriasis seemed to be more sensitive to stressful events. We divided the events described by Holmes and Rahe into three categories: family, personal, and job/financial problems. Family matters were mentioned by 42.7% of psoriatic patients, statistically significant compared with controls (P < 0.0001). In 35% of psoriatic cases, "the stressful event" was represented by the illness/death of someone dear. Both "personal" (25.6%; P = 0.02) and "job/financial problems" (31.6%; P < 0.0001) were significantly different compared with controls. CONCLUSIONS Stressful events could be highly related to psoriasis (especially in recurrences/extensions). Problems related to family are the most often involved with counseling being suggested.
Collapse
|
14
|
Escalas J, Guerra A, Rodríguez-Cerdeira M. Tratamiento con psicofármacos de los trastornos psicodermatológicos. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
15
|
El-Nour H, Santos A, Nordin M, Jonsson P, Svensson M, Nordlind K, Berg M. Neuronal changes in psoriasis exacerbation. J Eur Acad Dermatol Venereol 2009; 23:1240-5. [DOI: 10.1111/j.1468-3083.2009.03287.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Kossakowska MM, Cieścińska C, Jaszewska J, Placek WJ. Control of negative emotions and its implication for illness perception among psoriasis and vitiligo patients. J Eur Acad Dermatol Venereol 2009; 24:429-33. [PMID: 19744257 DOI: 10.1111/j.1468-3083.2009.03432.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of the study was to determine the intensity of control over negative emotions of anger, depressed mood, and anxiety in certain skin diseases such as psoriasis and vitiligo, and to define the predictors of this emotional control in terms of the illness perception in the following context: duration of illness, age at onset, subjective knowledge of the causes of illness, subjective sense of control over the disease. METHODS The study included 60 patients with psoriasis (n = 30) and vitiligo (n = 30) as well as healthy persons (n = 60) matched to the experimental group in terms of gender, age, and level of education. Control of negative emotions was examined by means of Watson and Greer's Courtauld Emotional Control Scale (Polish adaptation by Juczynski) and the illness perception by means of Kossakowska's Chronic Patients Questionnaire. RESULTS The research concludes that psoriasis patients control negative emotions more intensively than healthy people. Vitiligo patients on the other hand do not differ in the control of negative emotions compared with healthy subjects. There are no significant predictors of negative emotional control in vitiligo. In psoriasis gender and age are the main contributors to negative emotional control and anger control is predicted by the age at onset as well. CONCLUSION The specificity of the skin disease affects maladaptive negative emotional control and the suggestion is to use psychological treatment in hospitalised psoriasis in particular.
Collapse
Affiliation(s)
- M M Kossakowska
- Department of Clinical and Health Psychology, Warsaw School of Social Sciences and Humanities Faculty in Sopot, Sopot, Poland.
| | | | | | | |
Collapse
|