Psoriasis is a chronic inflammatory disease with a pronounced genetic component. The disease significantly affects the physical and psychosocial state of the patient, as well as the quality of his life. Although psoriasis has traditionally been considered a dermatological pathology exclusively, to date, enough data has been accumulated indicating the systemic nature of the lesion and the concomitant involvement of other organs and systems. The prevalence of comorbid conditions among patients with psoriasis is quite high, and depression is one of the common disorders that accompanies it.
Depression is a mental disorder characterized by a pathologically low mood with a negative, pessimistic assessment of oneself, one’s position in the surrounding reality, and one’s future. It is known that depressive conditions are one of the factors in the chronicity of psoriasis. According to Koo et al. (2017), “psychiatric disorders can both result from and contribute to progression of psoriasis, suggesting that psoriasis and psychiatric conditions, such as depression, may have overlapping biological mechanisms” (p. 1999). Moreover, psychiatric diagnoses can often contribute to the development of chronic medical conditions (Cabassa et al., 2013). As a result, the duration of remission is reduced so that the objective and subjective manifestations of the skin disease increase. Thus, the patient’s usual lifestyle is disrupted, and the possibilities of their recovery are limited.
Considering psoriasis as the cause of the development of depressive disorders, many researchers assign a decisive role to the severe skin itching that accompanies psoriasis. Moreover, the defects in appearance are associated with subsequent stigmatization and discrimination of patients with psoriasis. The presence of painful skin lesions that bleed and are accompanied by itching and burning negatively affects the general well-being of the patient, causing anxiety about their appearance, emotional upset, and shame. All of this can result in low self-esteem, stigmatization, and social isolation.
The depressive state of patients with psoriasis is also characterized by more pronounced anxiety. Patients often report that they are nervous about things that did not bother them before. Their experiences can be defined as sensitive ideas of attitudes, as it usually seems to the patients that those around them are unfriendly, that they are disliked due to their illness. This is due to the fact that because of skin rashes, patients often face negative attitudes toward them. Sahi et al. state that “fear of social rejection and self-stigmatization act as a fuel to fire inflaming depression in psoriatic patients” (p. 9708). They hesitate to appear in public places, on the beach, in the pool, or even on public transport, which leads to social restrictions and problems in personal relationships. At the same time, depression in patients without skin pathology is also characterized by weakness and insomnia. People with psoriasis and depression often complain that any action requires additional effort from them, and sleep disturbances cause additional discomfort, as well. It can be concluded that psoriasis and depression together create a vicious circle, where one illness reinforces the other.
References
Cabassa, L. J., Humensky, J., Druss, B., Lewis-Fernández, R., Gomes, A. P., Wang, S., & Blanco, C. (2013). Do race, ethnicity, and psychiatric diagnoses matter in the prevalence of multiple chronic medical conditions? Medical Care, 51(6), 540–547. Web.
Koo, J., Marangell, L. B., Nakamura, M., Armstrong, A., Jeon, C., Bhutani, T., & Wu, J. J. (2017). Depression and suicidality in psoriasis: Review of the literature including the cytokine theory of depression. Journal of the European Academy of Dermatology and Venereology, 31(12), 1999–2009. Web.
Sahi, F. M., Masood, A., Danawar, N. A., Mekaiel, A., & Malik, B. H. (2020). Association between psoriasis and Depression: A traditional review. Cureus. Web.