“The skin is the largest organism in the body – it’s its defense against the world – so it makes sense that the immune system is very active in the skin”, Tina Bhutani, MD, MAS, dermatologist and co-director of the University from the California psoriasis and skin treatment center in San Francisco (UCSF) and the clinical research unit in dermatology at UCSF, says SELF. But, she adds, the researchers don’t know why some people have psoriasis and others don’t.
“We know that patients have a genetic predisposition, but in addition, there is something about the environment that triggers their psoriasis,” says Dr. Bhutani. “In some it could be an infection, in others it could be some kind of stress, like psychological or physical stress on the body.”
The relationship between psoriasis and mental health can be a vicious cycle.
Research has shown that psoriasis can contribute to or worsen various mental health problems, including depression, anxiety, bipolar disorder, eating disorders, etc. If you have psoriasis, you may be intimately aware of how it works, especially now, as we all experience unprecedented mental strain from the new coronavirus.
While this is a bit of a chicken and egg situation, Dr. Bhutani says that mental health issues like anxiety or depression can trigger the onset of psoriasis or trigger and exacerbate flare-ups. Beyond that, “there are studies showing that major stressful life events, such as death in the family, can lead to the onset of new psoriasis,” Joel Gelfand, MD, MSCE (Master of Science in Clinical Epidemiology), professor of dermatology and epidemiology and director of the Center for Psoriasis Treatment and Phototherapy at the Perelman School of Medicine at the University of Pennsylvania, says SELF.
On the other hand, the fact that psoriasis can help you develop a mental health problem (or make it worse). “There are studies that show that psoriasis patients are more likely to develop problems such as anxiety and depression over time,” says Dr. Gelfand.
Anyone worried about not fitting into narrow definitions of beauty can understand how a visible skin condition can harm a person’s mental health. “We can imagine how the physical [stigma] psoriasis – especially when plaques affect exposed areas of the skin – can affect mood and interpersonal interactions in a negative way, “says Evan Rieder, MD, assistant professor of dermatology at NYU Langone, who is board certified administration in psychiatry and dermatology, says SOI. “These can happen both by the way a person with psoriasis perceives [themselves], but also through the reactions of others to their skin. “
Like many people with psoriasis, Jennifer Pellegrin, 36, knows only too well how the disease can affect a person’s social life and mental health. She was diagnosed with psoriasis at the age of 15 and psoriatic arthritis at 25, followed by depression a year later and then by anxiety. “Psoriasis causes an exacerbation of my [mental health conditions]», She explains to SELF in an e-mail. “I sometimes spend days when I cancel all the plans. I can’t wait to go out, start to prepare and boom: anxiety strikes. I feel hideous and I will not leave the house. “
In addition to the more obvious ways that psoriasis and mental health can play out, experts have done a lot of research on the biological mechanisms that can link psoriasis and various mental health problems. A systematic review of 2016 Journal of clinical and aesthetic dermatology reviewed 57 studies on the subject, noting that psychological stress and depression can stimulate the release of pro-inflammatory cytokines, which are molecules released as part of the immune response. The inflammation they cause seems capable of further worsening the symptoms of both psoriasis and conditions like depression. However, there is conflicting research on this subject; part of the literature found no definitive association between psoriasis and psychological problems like stress.