ASSOCIATION BETWEEN CHRONIC STRESS AND THE INTENSITY AND RECURRENCE OF PSORIATIC SYMPTOMS
Abstract
Psoriasis is a chronic inflammatory skin disease that significantly impairs quality of life and often presents with systemic manifestations. While its exact etiology remains unclear, stress is increasingly recognized as a major factor in triggering and exacerbating the disease. This paper reviews the current scientific literature on the complex bidirectional relationship between psychological stress and psoriasis, with particular focus on the underlying neuroendocrine mechanisms and clinical consequences. Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic–adrenal–medullary (SAM) system plays a key role in stress-related immune activation, promoting inflammation and impairing skin barrier function. Patients identified as "stress responders" experience more frequent and severe flare-ups and often show reduced responsiveness to standard dermatologic therapies. Moreover, the visible and chronic nature of psoriatic lesions contributes to emotional distress, forming a vicious cycle of stress and symptom aggravation. Integrative therapeutic approaches—including relaxation techniques, psychotherapy, and pharmacological treatment with antidepressants or anxiolytics—have demonstrated potential in reducing symptom severity and improving patient well-being. These findings support the implementation of a multidisciplinary model of care that addresses both dermatological and psychological dimensions of psoriasis for more effective, patient-centered management.
References
National Psoriasis Foundation website. About psoriasis: statistics. Available at: http:// www.psoriasis.org/netcommunity/learn/about-psoriasis/statistics. Last accessed: December 14, 2010.
Psychological Stress and Depression in Psoriasis Patients – a Dermatologist’s Perspective
Current and potential new therapies for the treatment of psoriasis. The Pharmaceutical Journal - http://www.pharmaceutical-journal.com/news-and-analysis/news/current-and-potential-new-therapies-for-the-treatment-of psoriasis. 2010.
Boyd AS, Neldner KH. The isomorphic response of Koebner. Int J Dermatol. 1990;29:401–410. doi: 10.1111/j.1365-4362.1990.tb03821.x. [DOI] [PubMed] [Google Scholar]
Weigle N, McBane S. Psoriasis. Am Fam Physician. 2013;87:626–633. [PubMed] [Google Scholar]
Devrimci-Ozguven H, Kundakci TN, Kumbasar H, et al. The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. J Eur Acad Dermatol Venereol 14(4):267-71 (2000 Jul).
Koo JY. Psychodermatology: a practical manual for clinicians. Cur Prob Dermatol 6:204-32 (1995).
Picardi A, Abeni D. Stressful life events and skin diseases: disentangling evidence from myth. Psychother Psychosom 70(3):118-36 (2001 May-Jun).
Gupta MA, Gupta AK, Kirkby S, et al. A psychocutaneous profile of psoriasis patients who are stress reactors. A study of 127 patients. Gen Hosp Psychiatry 11(3):166-73 (1989 May).
Paykel ES, Prusoff Brigitte A, Uhlenhuth EH. Scaling of life events. Arc Gen Psychiatry. 1971;25:340. doi: 10.1001/archpsyc.1971.01750160052010. [DOI] [PubMed] [Google Scholar]
Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11:213. doi: 10.1016/0022-3999(67)90010-4. [DOI] [PubMed] [Google Scholar]
Finzi AF, Benelli C. A clinical survey of psoriasis in Italy; 1st AISP report. J Eur Acad Derm Venereol. 1998;10:125–129. [PubMed] [Google Scholar]
Rigopoulos D, Gregoriou S, Katrinaki A, et al. Characteristics of psoriasis in Greece: an epidemiological study of a population in a sunny Mediterranean climate. Eur J Dermatol 20(2):189-95 (2010 Mar-Apr).
Seville RH. Psoriasis and stress. Br J Dermatol 97(3):297-302 (1977 Sep).
Al’Abadie MS, Kent GG, Gawkrodger DJ. The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. Br J Dermatol 130(2):199-203 (1994 Feb).
Zachariae R, Zachariae H, Blomqvist K, et al. Self-reported stress reactivity and psoriasis-related stress of Nordic psoriasis sufferers. J Eur Acad Dermatol Venereol 18(1):27-36 (2004 Jan).
Verhoeven EW, Kraaimaat FW, de Jong EM, et al. Individual differences in the effect of daily stressors on psoriasis: a prospective study. Br J Dermatol 161(2):295-9 (2009 Aug).
Naldi L, Chatenoud L, Linder D, et al. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 125(1):61-7 (2005 Jul).
Jankovic S, Raznatovic M, Marinkovic J, et al. Risk factors for psoriasis: A case-control study. J Dermatol 36(6):328-34 (2009 Jun).
Stewart TJ, Tong W, Whitfeld MJ. The associations between psychological stress and psoriasis: a systematic review. International Journal of Dermatology. 2018;57:1275–1282. doi: 10.1111/ijd.13956. [DOI] [PubMed] [Google Scholar]
Fortune DG, Richards HL, Kirby B, et al. Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy. Arch Dermatol 139(6):752-6 (2003 Jun).
Arnetz BB, Fjellner B, Eneroth P, et al. Stress and psoriasis: psychoendocrine and metabolic reactions in psoriatic patients during standardized stressor exposure. Psychosom Med 47(6):528-41 (1985 Nov-Dec).
Buske-Kirschbaum A, Ebrecht M, Kern S, et al. Endocrine stress responses in TH1-mediated chronic inflammatory skin disease (psoriasis vulgaris)–do they parallel stress-induced endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)? Psychoneuroendocrinology 31(4):439-46 (2006 May).
Evers AW, Verhoeven EW, Kraaimaat FW, et al. How stress gets under the skin: cortisol and stress reactivity in psoriasis. Br J Dermatol 163(5):986-91 (2010 Nov).
Richards HL, Ray DW, Kirby B, et al. Response of the hypothalamic-pituitary-adrenal axis to psychological stress in patients with psoriasis. Br J Dermatol 153(6):1114-20 (2005 Dec).
Woźniak E, Owczarczyk-Saczonek A, Placek W. Psychological stress, mast cells, and psoriasis-is there any relationship? Int J Mol Sci. 2021;22(24):13252. doi: 10.3390/ijms222413252. [DOI] [PMC free article] [PubMed] [Google Scholar]
Moynihan J., Rieder E., Tausk F. Psychoneuroimmunology: the example of psoriasis. Giornale Italiano di Dermatologia e Venereologia. 2010;145(2):221–228. [PMC free article] [PubMed] [Google Scholar]
Steptoe A., Hamer M., Chida Y. The effects of acute psychological stress on circulating inflammatory factors in humans: a review and meta-analysis. Brain, Behavior, and Immunity. 2007;21(7):901–912. doi: 10.1016/j.bbi.2007.03.011. [DOI] [PubMed] [Google Scholar]
Maes M., Song C., Lin A., et al. The effects of psychological stress on humans: increased production of pro-inflammatory cytokines and Th1-like response in stress-induced anxiety. Cytokine. 1998;10(4):313–318. doi: 10.1006/cyto.1997.0290. [DOI] [PubMed] [Google Scholar]
Russo PA, Ilchef R, Cooper AJ. Psychiatric morbidity in psoriasis: a review. Australas J Dermatol 45(3):155-9 (2004 Aug).
Kimball AB, Jacobson C, Weiss S, et al. The psychosocial burden of psoriasis. Am J Clin Dermatol 6(6):383-92 (2005).
A. Kouris,1 E. Platsidaki,2 C. Kouskoukis,1 C. Christodoulou3 1 Psychological parameters of psoriasis Department of Dermatology.Democritus University Medical School, Alexandroupolis, 2 Department of Dermatology and Venereology, "Andreas Syggros" Skin Hospital, Athens, 3 2nd Department of Psychiatry, "Attikon" General Hospital, Athens University Medical School, Athens, Greece Psychiatriki 2017, 28:54–59
M M Heller1, E S Lee, J Y Koo Stress as an influencing factor in psoriasis PMID: 21611682
Seng TK, Nee TS. Group therapy: a useful and supportive treatment for psoriasis patients. Int J Dermatol 36(2):110-2 (1997 Feb)
Winchell SA, Watts RA. Relaxation therapies in the treatment of psoriasis and possible pathophysiologic mechanisms. J Am Acad Dermatol 18(1 Pt 1):101-4 (1988 Jan).
Griffiths CE, Richards HL. Psychological influences in psoriasis. Clin Exp Dermatol 26(4):338-42 (2001 Jun).
Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med 60(5):625-32 (1998 Sep-Oct).
Hardman R, Hopkins EJ, Pye AM, Solomon M, Solomon S. A trial of imipramine in the treatment of psoriasis. J Coll Gen Pract 10(3):315-6 (1965 Nov).
Hebel E. [Treatment of psoriasis with imipramine (Tofranil)]. Ugeskr Laeger 128(1):20-1 (1966 Jan 6).
Alpsoy E, Ozcan E, Cetin L, et al. Is the efficacy of topical corticosteroid therapy for psoriasis vulgaris enhanced by concurrent moclobemide therapy? A double-blind, placebo-controlled study. J Am Acad Dermatol 38(2 Pt 1):197-200 (1998 Feb).
Modell JG, Boyce S, Taylor E, et al. Treatment of atopic dermatitis and psoriasis vulgaris with bupropion-SR: a pilot study. Psychosom Med 64(5):835-40 (2002 Sep-Oct).
Katon W, Ciechanowski P. Initial treatment of depression in adults. In: UpToDate. Waltham, MA.
DuPont RL, Greene W, Lydiard R. Sedatives and hypnotics: pharmacology and epidemiology. In: UpToDate. Waltham, MA.
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