Psoriasis increases psychological burden, depression

Psoriasis has a substantial psychological burden that affects quality of life for many patients, according to a presentation at the European Academy of Dermatology and Venereology virtual congress.

“Psoriasis is a major global health problem with a major impact on patients’ lives, which contributes to significant socioeconomic burden,” Dimitrios Ioannides, MD, PhD, from Aristotle University of Thessaloniki, said.

The psychological burden of psoriasis includes multiple dimensions of stigmatization, including sensitivity to opinions and attitudes of others, anticipation of rejection, feelings of being flawed, guilt and shame, secretiveness and reduction in self-esteem.

“The vast majority of patients reported experiences with discrimination and humiliation, which highlights the importance of effective symptom control of psoriasis,” Ioannides said. “Furthermore, the emotional toll is not necessarily proportional to the extent of the disease.”

A metanalysis of 98 studies found nearly 30% of patients with psoriasis experienced depression symptoms, and 10% of those were on antidepressants. In addition, more than 50% experienced at least one psychiatric disorder.

Compared with the general population, those with psoriasis showed a higher rate of depression, anxiety and suicidal ideation, with adjusted hazard ratios of 1.39, 1.31 and 1.44, respectively.

“It is clear depression exacerbates psoriasis, psoriasis leads to depression, and both share etiopathogenic mechanisms,” Ioannides said.

Early treatment of psoriasis has been shown to reduce depression and psychological effects, with biologic treatments showing the most improvement, he said.

“The ultimate goal is an integrated, comprehensive treatment of psoriatic disease taking into account not only the specialists’ perspective, but also addressing all dimensions of patients’ lives with the help of other specialists, including psychologists,” Ioannides said.