driven by alterations in the hypothalamic-pituitary-adrenal axis and the function of the sympathetic adrenal-medullary system, or by inflammatory mechanisms involving abnormal activation of mast cells.1,4 Inflammatory responses to stress may also cause a redirection of leukocytes to the skin. However, none of these theories has been supported by evidence from clinical trials. 1,4 At the same time, the symptoms of psoriasis are well known to exacerbate anxiety and stress and worsen the symptoms.1

Psychological Interventions for Psoriasis

While dermatologic therapies for psoriasis show good efficacy in reducing the severity of skin manifestations, more general effects on quality of life and well-being were not observed.4 These reviews all suggest that psychological treatment as adjunctive therapy for psoriasis seems warranted.1-4

A 2004 study by Dr DG Fortune of the department of behavioral medicine, Hope Hospital, Salford Royal Hospitals NHS Trust, Manchester, United Kingdom, and colleagues,5  reported improvements with the use of psychological therapies such as cognitive behavioral therapy and meditation, which has been supported by limited studies.4 More recently, Dr Y Chen of Guangdong Provincial Dermatology Hospital, Guangzhou, China, and colleagues,6 evaluated the effectiveness of cognitive behavioral therapy, as well as psychological counseling, education, and social skills training in 16 studies (including 5 RCTs) and was unable to conclusively determine the effect of these interventions. The investigators specifically pointed to a need for future RCTs to validate interventions and help identify the patient populations most likely to benefit from these interventions.6

Stewart and colleagues also cited a lack of data and concluded that future research should be focused on the potential gains of stress-reduction therapies on the onset, recurrence, and severity of psoriasis symptoms.4 In the short term, they recommended enhancing current clinical practice with the addition of psychological therapies. “We suggest clinicians include ‘stress’ as a trigger factor in their psoriasis assessment and consider psychological interventions as adjuncts, particularly in those who identify as “stress-responders,” the researchers wrote.

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1. Heller MM, Lee ES, Koo JY. Stress as an influencing factor in psoriasis. Skin Therapy Lett. 2011 May;16:1-4. Accessed March 15, 2019.

2. Snast I, Reiter O, Atzmony L, et al. Psychological stress and psoriasis: a systematic review and meta-analysis.  Br J Dermatol. 2018;178(5):1044-1055.

3. Dodoo-Schittko F. Psoriasis: the significance of psychological stress.  Br J Dermatol. 2018;178(5):1002.

4. Stewart TJ, Tong W, Whitfeld MJ. The associations between psychological stress and psoriasis: a systematic review. Abstract. Int J Dermatol. 2018;57:1275-1282.

5. Fortune DG, Richards HL, Griffiths CE. Psychologic factors in psoriasis: consequences, mechanisms, and interventions. Dermatol Clin. 2005;23(4):681-694.

6.  Chen Y, Xin, T, Cheng AS. Evaluating the effectiveness of psychological and/or educational interventions in psoriasis: a narrative review. J Dermatol. 2014;41(9):775-778.