Psychological Comorbidities in Palmoplantar Psoriasis and Psoriatic Arthritis: A Systematic Review

Psoriasis, a chronic inflammatory skin disorder, is often accompanied by psychological comorbidities. While the psychological effects of plaque psoriasis are well-documented, other psoriasis subtypes, such as guttate, erythrodermic, pustular, and palmoplantar psoriasis (PPP), remain less studied. This review aimed to examine psychological comorbidities in less-studied psoriasis variants. However, the available literature was limited to PPP and psoriatic arthritis (PsA). A comprehensive search of Medline, Embase, PsycINFO, and PubMed was conducted up to February 2025. Data were extracted on psychological comorbidities, disease severity, and patient demographics in patients with PPP and/or PsA. Seventeen studies (76,567 patients) were included. Depression prevalence in PsA ranged from 7.1% to 41%. In PPP, depression prevalence ranged from 5.7% in Japan to 17.1% in the United States. Anxiety prevalence ranged from 5.1% to 61.4%. Both depression and anxiety were more severe in patients with higher disease activity, with depressed patients being over 4 times more likely to report higher disease severity (AOR: 4.43, P = .001). Additional psychological comorbidities included sleep disturbances (38%) and mood disorders in PPP patients (19.6%). Functional impairment ranged from mild to moderate, with moderate but variable discomfort reported in pain assessments. Current evidence on psychological comorbidities in non-plaque psoriasis is limited to PsA and PPP. PsA and PPP can potentially be associated with an elevated risk for psychological comorbidities, particularly depression, anxiety. These findings highlight the need for comprehensive mental health screening and management in these patient populations. Further research is needed to characterize the psychological burden in other non-plaque psoriasis subtypes.