Effective Treatment of Psoriasis May Lead to Reversal of Alexithymia

Alexithymia and associated disease burden, which may include poor quality of life, anxiety, depression, and alcohol abuse, were significantly reduced and may be reversed in patients with effective psoriasis treatment, according to a study published in the British Journal of Dermatology.

The investigators of this observational, multicenter study sought to determine whether real-life therapeutic interventions used to treat patients with psoriasis were effective in reversing alexithymia.

The study sample included 536 consecutive patients diagnosed with plaque psoriasis recruited from 61 outpatient dermatological centers in 13 countries. Investigators followed the participants for a year, examining the prevalence of alexithymia and other psychosocial comorbidities, including self-reported outcomes of depression, anxiety, quality of life, and alcohol dependency, in patients with psoriasis. Alexithymia was defined by a score of 61 or greater in the Toronto Alexithymia Scale, and prevalence rates of alexithymia were assessed at baseline, 6 months, and 1 year.

Patients were treated with phototherapy (49.6%) or received systemic psoriasis treatment (50.4%). Overall, alexithymia was prevalent in 26.7% (95% CI, 23.0-30.6%) of the cohort at baseline. The investigators observed a statistically significant decrease in the prevalence of alexithymia over the study course, with 21.2% (95% CI, 17.8-25.0%) reporting alexithymia at 6 months and 18.8% (95% CI, 15.3-22.7%) reporting alexithymia at 1 year. Of the patients who were alexithymic at baseline, more than half (53.8%) experienced reversion. Alexithymia reversal was higher in patients who achieved control of their psoriasis, and reversal was associated with significant improvements in quality of life, anxiety, and depression. Additionally, these patients reported a near threefold reduction of alcohol use at follow-up.

One limitation of the study was its observational design, which inhibited ascertaining causation in the association between severity of psoriasis and alexithymia reversion. Because the study only involved patients with a short disease duration, the results cannot be generalized to include patients with long-term psoriasis. Finally, the association between alexithymia and depression may be limited by the accuracy of the Hospital Anxiety and Depression Scale used in this study.

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The study investigators concluded that the reversibility of alexithymia and related disease burden was associated with tight control of psoriasis using real-life systemic interventions. In addition, hazardous alcohol use, which is related to increased mortality in psoriasis patients, was significantly reduced in participants who experienced reversal of alexithymia.

Disclosures: Multiple authors declare affiliations with Janssen Pharmaceutica. Please see original reference for a full list of authors’ disclosures.

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Sampogna F, Puig L, Spuls P, et al. Reversibility of alexithymia with effective treatment of moderate to severe psoriasis: longitudinal data from EPIDEPSO [published online October 16, 2018]. Br J Dermatol. doi:10.1111/bjd.17259