Psychological parameters of psoriasis

Psoriasis is a chronic, inflammatory scaling dermatosis. The marked visible appearance of the lesions have a negative impact on body image that leads to decreased self-esteem, hence seriously compromising the patient's quality of life. The clinical picture critically affects the social well-being of the patient since the disease is commonly misunderstood and feared by the social environment as being contagious. The patient feels stigmatized and this further intensifies their lack of self-confidence and self-esteem. Feelings of shame and guilt increase the tendency toward suicidal ideation. The poor quality of life of psoriatic patients has been associated with excessive alcohol consumption, increased smoking and greater use of tranquilizers, sedatives and antidepressants. As far as mental impairment is concerned, a correlation has been found between psychological stress and the clinical severity of symptoms: the more mentally affected the patient, the more severe the dermatologic lesions. Similarly, stressful life events constitute a major risk for the occurrence and recurrence, exacerbating the severity and duration of the symptoms. Depression and anxiety can worsen the disease or cause resistance to treatment or patient's indifference, which in turn can lead to expensive and prolonged treatment. Not least, the disease itself contributes to anxiety, depression and psychological stress, thus creating a "vicious circle" that is difficult to manage. Given that women seem to invest more in their personal appearance than men, it is hardly surprising that female psoriatic patients report higher levels of depression. Similarly, the risk of mental disorders is also higher in younger patients for whom body image plays an equally significant role. The severity of the disease, side effects of therapy and mental disorders are among the causes that have been attributed to sexual dysfunction reported by some psoriatic patients. At the social level, stigma, social rejection, feelings of shame, embarrassment and lack of confidence provoked by the disease often lead to the discontinuation of daily activities and social withdrawal. This review attempts to describe the prevalence of psychological stress and its negative social impact on patients with psoriasis. The recognition and treatment of these psychosocial problems may contribute to improving the quality of life for patients and reduce treatment costs. The collaboration between the psychiatrist and the dermatologist is a fundamental prerequisite toward addressing these issues.