PSORIASIS AND MENTAL HEALTH: A PSYCHODERMATOLOGICAL APPROACH WITH AN EMPHASIS ON PSYCHOTHERAPY

Psoriasis is a multifactorial, inflammatory, chronic disease caused by the complex interaction of genetic and environmental factors, including psychosocial distress. This review reasons the importance of the biopsychosocial model and why it should be considered when treating patients with psoriasis. We aimed to provide current evidence for the psychological etiopathogenesis, psychosocial comorbidities, psychosocial assessment, and psychological therapeutic interventions in psoriasis. The main pathways linking stress to psoriasis involve the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, peripheral nervous system, and immune system. Fear of embarrassment and social stigma is reported to be one of the main stressful factors in the onset or worsening of psoriasis. Mental disorders are the most common comorbidity in psoriatic patients, but they are still often overlooked and undertreated. Previous research has shown increased rates of sleep disorders, depression, anxiety, borderline personality disorder, and alcohol use disorder. Biological treatment of psoriasis could reduce symptoms of depression, anxiety, and insomnia in patients with psoriasis. According to research, psoriasis patients may have certain psychological characteristics, including type D personality, alexithymia, high vulnerability to stress, and escape-avoidance coping strategy. Mental and social health should be part of psoriasis severity assessment, especially in patients who carry an increased risk of mental illness. Cognitive behavioral therapy, mindfulness-based cognitive therapy, and relaxation therapy could be used to decrease psoriasis severity and improve the quality of life of psoriasis patients. Psychoanalytic evaluation can contribute to dermatologic practice by typifying unconscious conflicts, detecting the defense mechanisms for stress coping, and choosing the treatment on unconscious preferences. The collaboration between the dermatologist, family medicine specialist, psychologist, and psychiatrist can help to break the psychosomatic and somatopsychic vicious circles.