Mental factors and psychological disorders play an important role in the occurrence, development, regression and prognosis of psoriasis.
Psoriasis itself cannot be completely cured, which has a certain degree of impact on the quality of life of patients. Coupled with the fact that the disease greatly reduces the aesthetics of the organism, it can cause patients to develop depression, negativity, low self-esteem and other negative emotions. If there is no timely intervention, the patient may develop into a depressive state or even depression.
What’s more frightening is that once the patient is combined with depression, the progress of psoriasis may be aggravated by various factors, ultimately causing a vicious circle.
1.Psoriasis + depression: factors of combined morbidity
(1) Psychological factors
Psoriasis will not only make the patient’s body suffer, but also put a huge burden on the patient’s psyche, which is mainly related to the psychological trauma brought about by the patient’s long-term trapped appearance of skin lesions.
Psoriasis lesions are mainly papules, erythema and scales, and can involve all parts of the body, while or accompanied by pain, burning, itching and other discomfort. All of these symptoms can lead to anxiety, irritability or low self-esteem, causing a significant decrease in the patient’s sense of well-being in life and a multiplication of mood swings and shame.
Without effective intervention, depression ensues.
After the combined occurrence of depression, patients can induce autonomic dysfunction due to serious negative emotions, leading to abnormal sweat gland secretion, abnormal microvascular diastolic function, and impaired nutritional function of skin and hair, thus indirectly aggravating and worsening skin diseases and reverse stimulating the development of psoriasis.
(2) Physiological factors
In addition to psychological and quality of life effects, the co-morbidity of psoriasis and depression is also influenced by physiological factors, such as neuroimmunity, genetic factors, vitamin D and melatonin levels.
Neuroimmunity: the human brain indirectly regulates the number of intestinal flora through the central nervous system and immune nerves, and changes the intestinal microecological environment. Conversely, intestinal flora can also trigger depression by altering the permeability of the intestinal mucosal barrier and activating immune cells to release inflammatory factors, which in turn act on the vagal nervous system and affect central nervous function.
Genetic factors: There is a genetic relationship between both psoriasis and depression. Studies have found that genetic mutations associated with psoriasis can promote the release of pro-inflammatory cytokines in the body, which in turn causes an overactive hypothalamic-pituitary-adrenal axis in patients, leading to the inhibition of negative feedback and resulting in lower levels of serotonin neurotransmitters, thus triggering depression.
Vitamin D: Vitamin D deficiency may aggravate the inflammatory response and immune imbalance in the skin, which is detrimental to the therapeutic effect of psoriasis. Also, vitamin D is involved in the synthesis and release of 5-hydroxytryptamine. If vitamin D levels decrease, it may lead to lower levels of 5-hydroxytryptamine, which may cause emotional indifference, emotional instability, loss of pleasure, and induce or aggravate depression.
Melatonin: Melatonin is mainly used to regulate the sleep cycle and modulate the immune system for the purpose of improving the chronic inflammatory response. When melatonin enters into nerve cells and glial cells, it can also exert sedative, analgesic and antidepressant effects. Therefore, when melatonin levels are reduced, its antidepressant ability is reduced, which may lead to uncontrolled regulation of negative emotions, while aggravating the symptoms of psoriasis lesions and delaying the healing of incisions.
2.Psoriasis + depression: a combined treatment program
Clinically, for the co-morbidity of psoriasis and depression, the causal treatment is usually adopted.
(1) For psoriasis
Treatment is mainly aimed at the quality of life of psoriasis patients and reducing the recurrence rate of the disease. Clinical topical medications are the mainstay, and emollients are recommended for mild symptoms as an adjunct to treatment. For those with thick scales, salicylic acid preparations and coal tar can be used in conjunction with ultraviolet light, and topical dithranol ointment can be used to combat keratinization in recalcitrant chronic lesions.
Systemic medication is mainly based on immunosuppressants, immunomodulators, and retinoids, such as methotrexate, which is mostly recommended for recalcitrant, treatment-naïve psoriasis, cyclosporine, which is commonly used for severe psoriasis where conventional treatment is ineffective, and retinoids, which are mostly used to treat patients with more severe disease or who appear treatment-resistant.
In addition, phototherapy and biological agents are widely used. Patients with chronic psoriasis, especially those whose symptoms are significantly reduced or disappear in summer, are recommended to apply phototherapy such as ultraviolet light irradiation under the guidance of a doctor or, if conditions permit, to stay temporarily in an area with sufficient daylight. Biological agents are indicated for patients with moderate to severe psoriasis and/or psoriatic arthritis for whom conventional systemic therapy is ineffective, or poorly tolerated.
(2) For depression
Western medicine treatment is mainly based on selective 5-hydroxytryptamine reuptake inhibitors, followed by specific 5-hydroxytryptaminergic antidepressants, monoamine oxidase inhibitors and tricyclic antidepressants.
In addition, patients can also be assisted by cognitive-behavioral therapy by professional physicians to change thinking and behavior and eliminate bad emotions in order to achieve the purpose of short-course psychotherapy, while relieving their own anxiety and stress and reducing the stressful effects brought about by psoriasis.
When the patient’s depressive state is relieved, we can also control psoriasis more comfortably.
References
[1]Yang Su-Qing,Xing Guo-Qing,An Yue-Peng. Research progress on the correlation between psoriasis and depression [J]. Medical Review,2022,28(03):532-536.
[2]Fang Hongyuan,Xing Weibin,et al. Handbook of practical dermatological venereal diseases [M]. Beijing:People’s Health Publishing House,2016:598-600.