Psoriasis is a common chronic inflammatory skin disorder, and the disease state is influenced by multiple factors including stress during difficult life events, psychological disturbance, or lack of social support. Investigators have observed a temporal association to stress and psoriasis, and many investigators attribute this to a possible effect of stress on hypothalamic-pituitary-adrenal and sympathetic-adrenal-medullary axes. This article reviews the impact of stress on patients and their psoriasis and the approaches for proper management.
GuptaM., GuptaA.K., KirkbyS.A psychocutaneous profile of psoriasis patients who are stress reactors: a study of 127 patients. Gen Hosp Psychiatry.1989; 11: 166–73.
2.
FortuneD.G., RichardsH.L., MainC.J.What patients with psoriasis believe about their condition. J Am Acad Dermatol.1998; 39: 196–201.
3.
ManolacheL., Petrescu-SeceleanuD., BeneaV.Life events involvement in psoriasis onset/recurrence. Int J Dermatol.2010; 49: 636–41.
4.
HellerM.M., LeeE.S., KooJ.Stress as an influencing factor in psoriasis. Skin Therapy Lett.2011; 16: 1–4.
5.
ZachariaeR., OsterH., BjerringP.Effects of psychologic intervention on psoriasis: a preliminary report. J Am Acad Dermatol.1996; 34: 1008–115.
6.
GinsburgI.H., LinkB.G.Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol.1989; 20: 53–6.
PolenghiM.M., GalaC., CiteriA.Psoriasi ed eventi stressanti. G Ital Dermatol Venereol.1987; 122: 167–70.
9.
PolenghiM.M., GalaC., CiteriA.Psychoneuro-physiological implications in the pathogenesis and treatment of psoriasis. Acta Derm Venereol Suppl.1989; 146: 84–6.
10.
BalderoB., BrocaniG., BossiG.Psoriasi: incidenza di eventi stressanti nei sei 18. mesi precedenti la comparsa della malattia. Med Psicosom.1989; 34: 47–51.
11.
MalhotraS.K., MehtaV.Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria. Indian J Dermatol Venereol, Leprol.2008; 74: 594–9.
12.
PacanP., SzepietowskiJ.C., KiejnaA.Stressful life events and depression in patients suffering from psoriasis vulgaris. Dermatol Psychosomat.2003; 4: 142–45.
13.
RigopoulosD., GregoriouS., KatrinakiA.Characteristics of psoriasis in Greece: an epidemiological study of a population in a sunny Mediterranean climate. Eur J Dermatol.2010; 20: 189–95.
14.
SevilleR.H.Psoriasis and stress. Br J Dermatol.1977; 97: 297–302.
15.
Al'AbadieM.S., KentG.G., GawkrodgerD.J.The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. Br J Dermatol.1994; 130: 199–203.
16.
ChikanzaI.C., GrossmanA.S.Hypothalamic–pituitary-mediated immunomodulation: arginine vasopressin is a neuroendocrine immune mediator. Br J Rheumatol.1998; 37: 131–36.
17.
Buske-KirschbaumA., EbrechtM., KernS.Endocrine stress responses in TH1-mediated chronic inflammatory skin disease (psoriasis vulgaris)–do they parallel stress-induced endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)?Psychoneuroendocrinology.2006; 31: 439–36.
18.
ArnetzB.B., FjellnerB., EnerothP.Stress and psoriasis: psychoendocrine and metabolic reactions in psoriatic patients during standardized stressor exposure. Psychosom Med.1985; 47: 528–41.
19.
RupprechtM., RupprechtR., KornhuberJ.Elevated glucocorticoid receptor concentrations before and after glucocorticoid therapy in peripheral mononuclear leukocytes of patients with atopic 36 dermatitis. Dermatologica.1991; 183: 100–15.
20.
RichardsH.L., RayD.W., KirbyB.Response of the hypothalamic-pituitary-adrenal axis to psychological stress in patients with psoriasis. Br J Dermatol, 2005; 153: 1114–120.
21.
EversA., VerhoevenE., KraaimaatF.How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol.2010; 163: 986–91.
22.
HeimC., EhlertU., HellhammerD.H.The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology.2000; 25: 1–35.
23.
BoscarionJ.A.Posttraumatic stress disorder and physical illness. Results from clinical and epidemiologic studies. Ann N|Y Acad Sci.2004; 1032: 141–53.
24.
FriesE., HesseJ., HellhammerJ.A new view on hypocortisolism. Psychoneuroendocrinology.2005; 30: 1010–016.
25.
MillerG.E., ChenE., ZhouE.S.If it goes up, must it come down? Chronic stress and the hypothalamic–pituitary–adrenocortical axis in humans. Psychol Bull.2007; 133: 25–45.
26.
WingenveldK., HeimC., SchmidtI.HPA axis reactivity and lymphocyte glucocorticoid sensitivity in fibromyalgia syndrome and chronic pelvic pain. Psychosom Med.2008; 70: 65–72.
27.
HeimC., NaterU.M., MaloneyE.Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine function. Arch Gen Psychiatry.2009; 66: 72–80.
28.
Kunz-EbrechtS.R., Mohamed-AliV., FeldmanP.J.Cortisol responses to mild psychological stress are inversely associated with proinflammatory cytokines. Brain Behav Immun.2003; 17: 373–83.
29.
JanowskiK., PietrzakIndications for psychological intervention in patients with psoriasis. Dermatol Ther (Heidelb).2008; 21: 408–11.
30.
RiederE., TauskF.Psoriasis, a model of dermatologic psychosomatic disease: a psychiatric implications and treatments. Int J Dermatol.2012; 51: 12–26.
31.
FortuneD.G., RichardsH.L., GriffithsC.Psychological stress, distress, and disability in patients with psoriasis: Consensus and variation in the contribution of illness perceptions, coping and alexithymia. Br J Clin Psychol.2002; 41: 157–74.
32.
SengT.K., NeeT.S.Group therapy: a useful and supportive treatment for psoriasis patients. Int J Dermatol.1997; 36: 110–12.
33.
PriceM.L., MottahedinI., MayoP.R.Can psychotherapy help patients with psoriasis?Clin Exp Dermatol.1991; 16: 114–17.
34.
Kabat-ZinnJ., WheelerE., LightT.Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med.1998; 60: 625–32.
35.
FriedR.G., HussainS.Nonpharmacologic management of common skin and psychocutaneous disorders. Dermatol Ther.2008; 21: 60–8.
36.
HardmanR., HopkinsE.J., PyeA.M.A trial of imipramine in the treatment of psoriasis. J Coll Gen Pract.1965; 10: 315–16.
37.
HebelE.Treatment of psoriasis with imipramine (Tofranil). Ugeskr Laeger.1966; 128: 20–1.
38.
AlpsoyE., OzcanE., CetinL.Is the efficacy of topical corticosteroid therapy for psoriasis vulgaris enhanced by concurrent moclobemide therapy? A double-blind, placebo-controlled study. J Am Acad Dermatol1998; 38(2 pt 1): 197–200.
39.
Tan Pei LinL., KwekSK., KwekS.K.Onset of psoriasis during therapy with fluoxetine. Gen Hosp Psychiatry.2010; 446.e9–446.e10.
40.
HemlockC., RosenthalJ.S., WinstonA.Fluoxetine-induced psoriasis. Ann Pharmacother.1992; 26: 211–12.
41.
OsborneS.F., StaffordL., OrrK.G.Paroxetine-associated psoriasis. Am J Psychiatr.2002; 159: 2113.
42.
D'ErmeA.M., ZanieriF., CampolmiE. () Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study. J Eur Acad Dermatol Venereol. In press.
43.
MitraA., DubeyA., MittalA.Role of anti-depressant fluoxetine in the puva treatment of psoriasis vulgaris. Indian J Dermatol Venereol Leprol.2003; 67: 292–93.
44.
GuptaM.A., GuptatA.K.The use of antidepressant drugs in dermatology. J Eur Acad Dermatol Venereol.2001; 15: 512–18.
45.
ModellJ.G., BoyceS., TaylorE.Treatment of atopic dermatitis and psoriasis vulgaris with bupropion-SR: a pilot study. Psychosom Med2002; 64: 835–40.