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Stress impairs quality of life in patients with psoriasis vulgaris

Stephen Padilla
16 Aug 2018

An association exists between stress and quality of life (QoL) in patients with psoriasis vulgaris, according to a poster presented at the 23rd Asian-Australasian Regional Conference of Dermatology (RCD 2018) held in Surabaya, Indonesia.

Higher stress levels confer a greater effect on patients’ QoL, particularly in such variables as symptoms and feelings and daily activities.

“Screening for stress as triggering factor of psoriasis vulgaris is essential,” researchers said. “Thus, prompt treatment for stress can be performed, which eventually leads to increased QoL in psoriasis vulgaris patients.”

The study included 42 psoriasis vulgaris patients (aged 16–65 years) fulfilling both inclusion and exclusion criteria. The Depression, Anxiety and Stress Scale-21 (DASS-21) items scoring system was used to measure stress, while QoL was measured using the Dermatology Life Quality Index (DLQI) scoring system. [Suryawati N, et al, RCD 2018]

Most psoriasis vulgaris patients (mean age 45.93±11.07 years) were male (69.05 percent), Balinese (83.33 percent), senior high school graduates (47.62 percent) and private sector employees (52.38 percent). First onset ranged from 1–30 years, with a mean of 8.26±7.6 years. Measured stress had a mean of 10.81±10.00 (range, 0–42), while QoL showed a mean of 10.74±6.44 (range, 0–23).

Stress was a risk factor for increased DLQI in psoriasis patients (6.80; 95 percent CI, 0.96–48.33; p<0.05). Elevated stress score was positively associated with DLQI (r=0.53; p<0.05). In addition, stress had a positive correlation with symptoms and feelings and daily activities (r=0.38; p<0.05).

Furthermore, 31 patients (73.81 percent) developed psoriasis lesion triggered by stress.

“Stress is one of triggering factors for exacerbation of psoriasis lesions,” researchers said. “Stress effect on psoriasis vulgaris exacerbation is possibly mediated by immunology effect involving hypothalamus-pituitary-adrenal axis and [an] increase in reactivation of sympathetic adrenomedular, leading to activation of mast cells which cause neurogenic inflammation.”

In addition, psychological stress is a driver of phenotypic changes in circulating lymphocyte and is considered as a significant trigger for T-helper 1 cell-polarized inflammation in psoriasis, they added.

In a previous study, the investigators found that 50 percent of psoriasis patients, regardless of the severity of the disease, reported a significant change in their QoL. These patients, particularly women and older people (aged >55 years), experienced anxiety and symptoms of depression. [Medicina 2016;52:238-243]

Studies in Malaysia and Turkey both found that the QoL of patients with psoriasis was significantly impaired and even comparable with those with other chronic medical illnesses. [Int J Dermatol 2013;52:314-322; Eur J Dermatol 2015;25:169-176]

A chronic inflammatory skin disease, psoriasis vulgaris frequently causes discomfort, social stigma and psychological disorders such as depression, anxiety and stress affecting patients’ QoL, according to researchers.

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