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more than a skin disease
Mental Health
Among the most prevalent co-morbidities of psoriasis (PsO) are conditions affecting the mental health and psychological well-being of patients, including depression and suicidality.1-5 Symptoms of depressive disorders can include sustained depressed mood and/or the inability to feel pleasure, altered energy and appetite levels, and even impaired cognitive functioning.2 Such conditions may be difficult to diagnose accurately in a dermatology setting, but can significantly impact patients’ quality of life.6,7 A meta-analysis of publications found that depending on the screening method used and population included, among other factors, depression prevalence estimates in patients with PsO vary greatly between 4%–80% (with a pooled incidence of 28%).2,3,6,8-10 Furthermore, for people with PsO the risk of developing depression is at least 1.5 times higher than the general population, and the risk is associated with increased PsO severity and site of skin lesions.3,6,8,9,11 Additionally, patients with PsO may face social difficulties including stigmatization, embarrassment, and social inhibition.12
Mental Health
IL, interleukin; TNF-α, tumor necrosis factor-alpha.
Chen Y et al. Psych Res. 2011;188:224-230. Davami MH et al. Clin Neurosci. 2016;7:137-142. Ferreira BIRC et al. J Clin Aesthet Dermatol. 2016;9:36-43. Koo J et al. J Eur Acad Dermatol Venereol. 2017;31:1999-2009.
Mental Health
Although the exact neurobiological mechanism underlying the increased incidence of depression in PsO remains to be elucidated, PsO and depression are believed to share similar pathways related to systemic inflammation.9 Both psoriasis and depression share increased levels of pro-inflammatory cytokines such as interleukin [IL]-6 and tumor necrosis factor-alpha [TNF-α]).2,13 Exploratory studies on depressed patients indicated elevated levels of Th17 cells and IL-17A, as seen in PsO.14,15
Mental Health
IL, interleukin; TNF-α, tumor necrosis factor-alpha.
Chen Y et al. Psych Res. 2011;188:224-230. Davami MH et al. Clin Neurosci. 2016;7:137-142. Ferreira BIRC et al. J Clin Aesthet Dermatol. 2016;9:36-43. Koo J et al. J Eur Acad Dermatol Venereol. 2017;31:1999-2009.
Mental Health
It is important for dermatologists to be aware of the susceptibility of patients with PsO to depression and anxiety, as well as the increased risk of suicidality, and should consider informing their patients of these risks.16-18 Established screening tools that could be used by the dermatologist to evaluate for these conditions include the Patient Health Questionnaire (PHQ)-2 or the Goldberg Anxiety and Depression Scale.18 If these tools demonstrate evidence of depression, anxiety, or suicidality, patients could be referred to a mental health specialist.16-18 Improved awareness of the increased risk of mental health co-morbidities in patients with PsO might allow dermatologists to more effectively screen patients for these conditions.16
Mental Health
IL, interleukin; TNF-α, tumor necrosis factor-alpha.
Chen Y et al. Psych Res. 2011;188:224-230. Davami MH et al. Clin Neurosci. 2016;7:137-142. Ferreira BIRC et al. J Clin Aesthet Dermatol. 2016;9:36-43. Koo J et al. J Eur Acad Dermatol Venereol. 2017;31:1999-2009.
Mental Health
IL, interleukin; TNF-α, tumor necrosis factor-alpha.
Chen Y et al. Psych Res. 2011;188:224-230. Davami MH et al. Clin Neurosci. 2016;7:137-142. Ferreira BIRC et al. J Clin Aesthet Dermatol. 2016;9:36-43. Koo J et al. J Eur Acad Dermatol Venereol. 2017;31:1999-2009.
Among the most prevalent co-morbidities of psoriasis (PsO) are conditions affecting the mental health and psychological well-being of patients, including depression and suicidality.1-5 Symptoms of depressive disorders can include sustained depressed mood and/or the inability to feel pleasure, altered energy and appetite levels, and even impaired cognitive functioning.2 Such conditions may be difficult to diagnose accurately in a dermatology setting, but can significantly impact patients’ quality of life.6,7 A meta-analysis of publications found that depending on the screening method used and population included, among other factors, depression prevalence estimates in patients with PsO vary greatly between 4%–80% (with a pooled incidence of 28%).2,3,6,8-10 Furthermore, for people with PsO the risk of developing depression is at least 1.5 times higher than the general population, and the risk is associated with increased PsO severity and site of skin lesions.3,6,8,9,11 Additionally, patients with PsO may face social difficulties including stigmatization, embarrassment, and social inhibition.12
Mental Health
IL, interleukin; TNF-α, tumor necrosis factor-alpha.
Chen Y et al. Psych Res. 2011;188:224-230. Davami MH et al. Clin Neurosci. 2016;7:137-142. Ferreira BIRC et al. J Clin Aesthet Dermatol. 2016;9:36-43. Koo J et al. J Eur Acad Dermatol Venereol. 2017;31:1999-2009.
Although the exact neurobiological mechanism underlying the increased incidence of depression in PsO remains to be elucidated, PsO and depression are believed to share similar pathways related to systemic inflammation.9 Both psoriasis and depression share increased levels of pro-inflammatory cytokines such as interleukin [IL]-6 and tumor necrosis factor-alpha [TNF-α]).2,13 Exploratory studies on depressed patients indicated elevated levels of Th17 cells and IL-17A, as seen in PsO.14,15
Mental Health
IL, interleukin; TNF-α, tumor necrosis factor-alpha.
Chen Y et al. Psych Res. 2011;188:224-230. Davami MH et al. Clin Neurosci. 2016;7:137-142. Ferreira BIRC et al. J Clin Aesthet Dermatol. 2016;9:36-43. Koo J et al. J Eur Acad Dermatol Venereol. 2017;31:1999-2009.
It is important for dermatologists to be aware of the susceptibility of patients with PsO to depression and anxiety, as well as the increased risk of suicidality, and should consider informing their patients of these risks.16-18 Established screening tools that could be used by the dermatologist to evaluate for these conditions include the Patient Health Questionnaire (PHQ)-2 or the Goldberg Anxiety and Depression Scale.18 If these tools demonstrate evidence of depression, anxiety, or suicidality, patients could be referred to a mental health specialist.16-18 Improved awareness of the increased risk of mental health co-morbidities in patients with PsO might allow dermatologists to more effectively screen patients for these conditions.16
References
- Mehrmal S et al. J Am Acad Dermatol. 2020;84:46–52.
- Kleyn CE et al. Acta Derm Venereol. 2020;100:adv00020.
- Lukmanji A et al. J Cutan Med Surg. 2021;25:257-270.
- Singh S et al. J Am Acad Dermatol. 2017;77:425–440.
- Wu JJ et al. J Dermatol Treat. 2018;19:487-495.
- Dowlatashi EA et al. J Invest Dermatol. 2014;134:1542-1551.
- Strober B et al. J Am Acad Dermatol. 2017;78:70-80.
- Dommasch ED et al. Br J Dermatol. 2015;173:975–980.
- Koo J et al. J Eur Acad Dermatol Venereol. 2017;31:1999–2009.
- Kurd SK et al. Arch Dermatol. 2010;146:891–895.
- Łakuta P et al. Postepy Dermatol Alergol. 2018;35:60–66.
- Hayes J, Koo J. Dermatol Ther. 2010;23:174–180.
- Ferreira BIRC et al. J Clin Aesthet Dermatol. 2016;9:36–43.
- Chen Y et al. Psych Res. 2011 ;188 :224-230.
- Davami MH et al. Clin Neurosci. 2016 ;7 :137-142.
- Elmets CA et al. J Am Acad Dermatol. 2019;80:1073–1113.
- Singh S et al. J Am Acad Dermatol. 2017;77:425–440.
- Armstrong AW, Read C. JAMA. 2020;323:1945–1960.