Association of psychic stress with clinical severity and symptoms of psoriatic patients

The association of stress with psoriatic skin and joint symptoms was studied in 38 patients with psoriasis by dividing the patients into low-stress and high-stress groups based on their answers to four questionnaires (General health questionnaire, Somatization questionnaire, Depression questionnaire, and Life change questionnaire), measuring minor psychiatric disorder, psychosomatic reactivity, depression and life changes, respectively. Compared to the low-stress group (n = 21), the patients in the high-stress group (n = 17) had more severe skin and joint symptoms and a higher score, which in established psoriatic General severity score that was calculated by judging Psoriasis Area and Severity Index, activity of psoriasis and the presence of joint symptoms. All the four questionnaires showed higher morbidity frequency and higher score points. Actively spreading psoriasis was significantly associated with stressful life events for men but not for women. However, in the low-stress group, men had experienced significantly fewer stressful events than women. Psoriasis Area and Severity Index showed strong correlation with the Somatization score, but no differences between men and women. The General severity score correlated with the Somatization score, and the higher the General severity score (score > or = 6) the higher were all the four questionnaire scores. Also, patients having joint symptoms had higher scores in all of the four psychic questionnaires than patients without joint symptoms. By the chi-test, female patients with joint symptoms showed a significant correlation with the high General health questionnaire. The presence of joint symptoms showed a tendency for correlation in women with high depression level and in men with high somatization level. This study suggests that psychic stress is associated with exacerbation of psoriasis, and more attention to mental well-being should be paid at least in the case of those psoriatic patients seeking actively for medical care.