Getting under the Skin: Report from the International Psoriasis Council Workshop on the Role of Stress in Psoriasis

Cognitive behavior therapy as dermatological treatment: a narrative review

Cognitive behavior therapy (CBT) is efficacious in treating numerous psychological disorders. It is also effective in combination with medication for chronic pain, diabetes, and other diseases. Patients with skin disease report high levels of stress, anxiety, and negative feelings.

Objective

To summarize the findings on the utility of CBT for the improvement of skin status and quality of life in patients with dermatological conditions.

Methods

PubMed and Google Scholar databases were searched for relevant articles from database inception to the time of search (October 20, 2021). A total of 30 included studies featured 10 on psoriasis, 11 on atopic dermatitis, 4 on vitiligo, 4 on acne, and 1 study on alopecia areata.

Results

Several studies, including randomized controlled trials with large study samples, support the effectiveness of CBT and Internet CBT for a number of dermatological conditions. Patients who completed CBT courses were less likely to rely on dermatological healthcare during follow-up.

Limitations

There are a limited number of studies discussing the implementation of CBT for alopecia, acne, and vitiligo.

Conclusion

Patients who underwent CBT or Internet CBT in addition to skin care demonstrated improvement with quality of life and severity of skin disease as compared to controls only receiving standard of care treatment.

The indirect effect of a focus group for psoriatic patients on their caregivers

Psoriasis is a chronic skin disease involving not only epidermic damages but also psychological distress for patients and their family caregivers. Little is known about the effects of a psychological support for psoriatic patients on their caregivers’ well-being. The goal of the present study was to investigate the indirect effects of the participation in a dynamic focus group reserved for psoriatic patients on their caregivers in terms of quality of life. The study involved 52 psoriatic patients and 41 family caregivers. Patients’ wellbeing was assessed using the dermatology quality of life index, hospital anxiety and depression scale. The impact of the disease on caregivers was assessed using the family dermatology life quality index (FDLQI). Data were analyzed with linear mixed models. The caregivers of psoriatic patients involved in the psychodynamic focus group reported levels of FDLQI that decreased over time, therefore showing an improvement in their quality of life in relation to the pathology of their relatives; the caregivers of patients who did not participate in the psychodynamic focus group, instead, had levels of FDLQI that were stable over time. The results provide preliminary evidence that the group setting of the Psychodynamic Focus Group may alleviate the negative impact of psychosomatic disease on the caregivers.

A systematic review of cognitive and behavioral treatments for individuals with psoriasis

Background: Although there are effective dermatological treatments for psoriasis, a proportion of individuals also experience psychological distress not addressed by these treatments. Psychological factors may be targeted by cognitive behavioral therapy (CBT) which may in turn also decrease psoriasis severity.Method: A systematic review using PsycINFO, PubMed, and SCOPUS databases was performed in 2019 to examine the efficacy of treatments that delivered psychotherapy with a major cognitive/behavioral component to patients with psoriasis. Quality of included studies was assessed.Results: Nine randomized controlled trials with 8 unique samples met inclusion criteria. Study quality ranged from fair to good. Half of the studies found improved psoriasis severity following treatment. Several studies found improvements following treatment in anxiety, depression, and stress. The studies that reported non-significant findings on psychological outcomes had samples with healthy baseline psychological functioning. Nearly all studies that examined quality of life as an outcome found improvements following treatment.Conclusion: CBT as an adjunct to conventional dermatological treatments may be particularly beneficial for individuals with more severe pretreatment psychopathology in improving psoriasis severity, anxiety, and depression symptoms. CBT appears to be generally effective in improving quality of life. Greater methodological rigor is needed in future research.

Self-esteem is related to anxiety in psoriasis patients: A case control study

OBJECTIVE

In psoriasis, taking steps to improve emotional health is important to bring lasting benefits to patients' physical health and overall well-being. We aimed to identify factors that relate to anxiety in psoriasis and are potentially modifiable and that thus qualify as targets for future planned interventions for improving mental health. In this study, the importance of coping strategies and self-esteem as potential targets were tested.

METHODS

A total of 102 patients diagnosed with psoriasis, aged 26-65 years (M = 43.39 years, SD = 10.56) and 98 healthy controls (with an overall age, gender, educational attainment distribution similar to that of the cases) completed the Rosenberg's Self-Esteem Scale, the Coping Inventory for Stressful Situations, and the State-Trait Anxiety Inventory.

RESULTS

Patients with psoriasis compared to healthy controls reported significantly higher rates of anxiety and emotion- and avoidance-oriented coping strategies, presented lower rates of task-oriented coping strategies, and significantly lower levels of self-esteem. Importantly, our results revealed that self-esteem in psoriasis patients was strongly related to anxiety. Moreover, the increased rates of anxiety in psoriasis were not significantly associated with the coping strategies, suggesting that in patients with psoriasis coping strategies are secondary to other factors such as self-image and self-esteem.

CONCLUSIONS

The results identify self-esteem as a target to adopt in further interventions for psoriasis patients. Recommendations for future research and intervention development are discussed.

Regenerative and Protective Actions of the GHK-Cu Peptide in the Light of the New Gene Data

The human peptide GHK (glycyl-l-histidyl-l-lysine) has multiple biological actions, all of which, according to our current knowledge, appear to be health positive. It stimulates blood vessel and nerve outgrowth, increases collagen, elastin, and glycosaminoglycan synthesis, as well as supports the function of dermal fibroblasts. GHK’s ability to improve tissue repair has been demonstrated for skin, lung connective tissue, boney tissue, liver, and stomach lining. GHK has also been found to possess powerful cell protective actions, such as multiple anti-cancer activities and anti-inflammatory actions, lung protection and restoration of chronic obstructive pulmonary disease (COPD) fibroblasts, suppression of molecules thought to accelerate the diseases of aging such as NFκB, anti-anxiety, anti-pain and anti-aggression activities, DNA repair, and activation of cell cleansing via the proteasome system. Recent genetic data may explain such diverse protective and healing actions of one molecule, revealing multiple biochemical pathways regulated by GHK.

Psychosocial adjustment to skin conditions resulting in visible difference (disfigurement): What do we know? Why don't we know more? How shall we move forward?

This article offers an overview of the current understanding of the psychological factors and processes that play a part in the continuum of distress and positive adjustment in people who are affected by dermatological conditions that affect appearance. Despite research demonstrating the significant psychosocial challenges posed by visible difference and mounting evidence of the role played by psychosocial variables in the etiology, exacerbation, and treatment of skin conditions, current healthcare provisions focus predominantly on the amelioration of physical manifestations. Impediments to progress in the understanding of psychological adjustment, blocks to the development of effective interventions, and challenges to the implementation of integrated psychological and medical care are reviewed. A route map to advance current understanding and care provision is proposed.

Evolution, immunity and the emergence of brain superautoantigens

While some autoimmune disorders remain extremely rare, others largely predominate the epidemiology of human autoimmunity. Notably, these include psoriasis, diabetes, vitiligo, thyroiditis, rheumatoid arthritis and multiple sclerosis. Thus, despite the quasi-infinite number of "self" antigens that could theoretically trigger autoimmune responses, only a limited set of antigens, referred here as superautoantigens, induce pathogenic adaptive responses. Several lines of evidence reviewed in this paper indicate that, irrespective of the targeted organ (e.g. thyroid, pancreas, joints, brain or skin), a significant proportion of superautoantigens are highly expressed in the synaptic compartment of the central nervous system (CNS). Such an observation applies notably for GAD65, AchR, ribonucleoproteins, heat shock proteins, collagen IV, laminin, tyrosine hydroxylase and the acetylcholinesterase domain of thyroglobulin. It is also argued that cognitive alterations have been described in a number of autoimmune disorders, including psoriasis, rheumatoid arthritis, lupus, Crohn's disease and autoimmune thyroiditis. Finally, the present paper points out that a great majority of the "incidental" autoimmune conditions notably triggered by neoplasms, vaccinations or microbial infections are targeting the synaptic or myelin compartments. On this basis, the concept of an immunological homunculus, proposed by Irun Cohen more than 25 years ago, is extended here in a model where physiological autoimmunity against brain superautoantigens confers both: i) a crucial evolutionary-determined advantage via cognition-promoting autoimmunity; and ii) a major evolutionary-determined vulnerability, leading to the emergence of autoimmune disorders in Homo sapiens. Moreover, in this theoretical framework, the so called co-development/co-evolution model, both the development (at the scale of an individual) and evolution (at the scale of species) of the antibody and T-cell repertoires are coupled to those of the neural repertoires (i.e. the distinct neuronal populations and synaptic circuits supporting cognitive and sensorimotor functions). Clinical implications and future experimental insights are also presented and discussed.